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2012 CPT Coding Updates

Presented by: Raemarie Jimenez, CPC,

CPMA, CPC-I, CANPC, CRHC

Director of Education

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CPT® DisclaimerCPT copyright 2011 American Medical Association. All

rights reserved.

Fee schedules, relative value units, conversion factors

and/or related components are not assigned by the AMA,

are not part of CPT, and the AMA is not recommending

their use. The AMA does not directly or indirectly practice

medicine or dispense medical services. The AMA assumes

no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical

Association.

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Objective

Overview of the New, Revised and Deleted CPT

codes for 2012

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Evaluation and Management

Decision Tree for New vs. Established

Patient is included in the 2012 manual

Definition for New and Established

Patients was Revised.

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New Patient

A new patient is one who has not received

any professional services from the

physician or another physician of the exact

same specialty and subspecialty who

belongs to the same group practice, within

the past three years.

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Established Patient

An established patient is one who has

received professional services from the

physician or another physician of the exact

same specialty and subspecialty who

belongs to the same group practice, within

the past three years.

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Initial Observation Care Codes (99218-

99220) where revised to include typical

time.

CPT Typical Time

99218 30 minutes

99219 50 minutes

99220 70 minutes

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Prolonged Services

Revisions include the removal of “physician” and

“face to face” in the code descriptions for 99354-

99359

Addition of “observation” as a site of service for

codes 99356-99357

Codes 99358-99359 are reported for prolonged

services without direct patient contact

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Integumentary System

11975 and 11977 Deleted

The codes were used to report the

insertion and removal with reinsertion of

implantable contraceptive capsules

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Revision to Coding Guidelines for Repairs

– Multiple repairs of different classifications

report with modifier 59

– Example: An intermediate repair of the arm

measuring 3.0 cm and a complex repair of the

abdomen measuring 4.5 cm

• Codes: 13101, 12031-59

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Skin Replacement Surgery

– Coding Guidelines updated

– Revised: Six Codes

– Deleted: 24 Codes

– New: Eight Codes

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New Skin Substitute Codes● 15271 Application of skin substitute graft to trunk, arms,

legs, total wound surface area up to 100 sq cm; first 25

sq cm or less wound surface area

● +15272 each additional 25 sq cm wound surface area, or

part thereof (List separately in addition to code for

primary procedure)

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New Skin Substitute Codes● 15273 Application of skin substitute graft to trunk, arms,

legs, total wound surface area greater than or equal to

100 sq cm; first 100 sq cm wound surface area, or 1% of

body area of infants and children

● +15274 each additional 100 sq cm wound surface area,

or part thereof, or each additional 1% of body area of

infants and children, or part thereof (List separately in

addition to code for primary procedure)

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New Skin Substitute Codes● 15275 Application of skin substitute graft to face, scalp,

eyelids, mouth, neck, ears, orbits, genitalia, hands, feet,

and/or multiple digits, total wound surface area up to 100

sq cm; first 25 sq cm or less wound surface area

● +15276 each additional 25 sq cm wound surface area, or

part thereof (List separately in addition to code for

primary procedure)

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New Skin Substitute Codes● 15277 Application of skin substitute graft to face, scalp,

eyelids, mouth, neck, ears, orbits, genitalia, hands, feet,

and/or multiple digits, total wound surface area greater

than or equal to 100 sq cm; first 100 sq cm wound

surface area, 1% of body area of infants and children, or

part thereof

● +15278 each additional 100 sq cm wound surface area,

or part thereof, or each additional 1% of body area of

infants and children or part thereof (List separately in


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New Skin Substitute Codes

Example: A 345 sq cm skin substitute graft of the right arm

and a 95 sq cm skin substitute graft of the left arm

Codes: 15273, 15274 x 4

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● +15777 Implantation of biologic implant (eg,

acellular dermal matrix) for soft tissue

reinforcement (eg, breast, trunk) (List separately

in addition to code for primary procedure)

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Musculoskeletal System

● 20527 Injection, enzyme (eg, collagenase), palmar

fascial cord (ie, Dupuytren’s contracture)

● 26341 Manipulation, palmar fascial cord (ie, Dupuytren’s

cord), post enzyme injection (eg, collagenase), single

cord

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Revision to Percutaneous Vertebroplasty

codes (22520-22522) to include a bone

biopsy when performed

Example: Vertebroplasty performed on L2

and a bone biopsy performed on T12.

Codes 22521, 20225-59

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Arthrodesis– Revised: 2 codes (22610, 22612)

– New: 2 codes

● 22633 Arthrodesis, combined posterior or

posterolateral technique with posterior interbody

technique including laminectomy and/or discectomy

sufficient to prepare interspace (other than for

decompression), single interspace and segment;

lumbar

● +22634 each additional interspace and segment

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27096 was revised to include CT or

fluoroscopic imaging guidance and

arthrography when performed

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Application of multi-layer compression system

29581 Application of multi-layer compression

system; leg (below knee), including ankle and

foot

29582 thigh and leg, including ankle and foot,

when performed

29583 upper arm and forearm

29584 upper arm, forearm, hand, and fingers

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• +29826 Arthroscopy, shoulder, surgical;

decompression of subacromial space with partial

acromioplasty, with coracoacromial ligament (ie,

arch) release, when performed (List separately

in addition to code for primary procedure)

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Description of meniscectomy codes 29880 and 29881

were revised to include chondroplasty when performed

on the same or separate compartment(s)

Example: Chondroplasty is performed on the medial

compartment of the right knee and a meniscectomy is

performed on the lateral compartment of the right knee

Code: 29881-RT

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Respiratory System

Revisions to coding guidelines in the

Lungs and Pleura subsection

Deleted: Eight codes

Revised: 22 codes

New: 18 codes

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Respiratory System

Code 32095 was deleted and replaced with three new

codes.

● 32096 Thoracotomy, with diagnostic biopsy(ies) of lung

infiltrate(s) (eg, wedge, incisional), unilateral

● 32097 Thoracotomy, with diagnostic biopsy(ies) of lung

nodule(s) or mass(es) (eg, wedge, incisional), unilateral

● 32098 Thoracotomy, with biopsy(ies) of pleura

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Respiratory System

Revision to Thoracotomy codes 32100-

32160

32404 was deleted. Use new code 32098

to report the service

32405 revised to include moderate

sedation

Revision to Removal of Lung codes

32440-32491

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Respiratory System

32500 was deleted and three new codes were added:

● 32505 Thoracotomy; with therapeutic wedge resection

(eg, mass, nodule), initial

● +32506 Thoracotomy; with therapeutic wedge resection

(eg, mass or nodule), each additional resection,

ipsilateral (List separately in addition to code for primary

procedure)

● +32507 Thoracotomy; with diagnostic wedge resection

followed by anatomic lung resection (List separately in


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Respiratory System

Thoracoscopy Video-Assisted Thoracic Surgery (VATS)

• 32602, 36203, 32605 have been deleted. Report with

revised code 32601

• 32660 was deleted

• 32607 Thoracoscopy; with diagnostic biopsy(ies) of lung

infiltrate(s) (eg, wedge, incisional), unilateral

• 32608 Thoracoscopy; with diagnostic biopsy(ies) of lung

nodule(s) or mass(es) (eg, wedge, incisional), unilateral

• 32609 Thoracoscopy; with biopsy(ies) of pleura

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Respiratory System

32657 was deleted. Three new codes were created:

• 32666 Thoracoscopy, surgical; with therapeutic wedge

resection (eg, mass, nodule), initial unilateral

• +32667 Thoracoscopy, surgical; with therapeutic wedge

resection (eg, mass or nodule), each additional

resection, ipsilateral (List separately in addition to code

for primary procedure)

• +32668 Thoracoscopy, surgical; with diagnostic wedge

resection followed by anatomic lung resection (List

separately in addition to code for primary procedure)

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Respiratory System

New codes 32669-32674

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Cardiovascular System

Pacemaker changes

– Changes to guidelines

• Radiologic S&I included with codes 33206-33249

(71090 was deleted)

• 76000 can be reported for diagnostic lead

evaluation without a lead procedure

– Revised: 14 codes

– New: 9 codes (all resequenced)

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Pacemaker changes continued• New or replacement permanent pacemaker with

leads reported with 33206-33208

• Insertion of pacemaker pulse generator only reported

with 33212-33213, 33221

• Removal and replacement of permanent pacemaker

pulse generator reported with 33227-33229

• Insertion of pacemaker leads reported with 33216,

33217 or 33217 and 33224

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Pacemaker changes continued

• Insertion or replacement of a pacing cardioverter-

defribrillator pulse generator and leads reported with

33249. 33225 would be reported with 33249 for a

multiple lead system

• Insertion of pacing cardioverter-defribrillator pulse

generator only reported with 33240, 33230-33231

• Removal with replacement of the cardioverter-

defribrillator pulse generator reported with 33262-

33264

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Cardiac Assist

Revised description for 33960 and 33961

was changed from 24 hours to initial day

and subsequent day,.

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Bypass Grafts

Deletion of codes 35548, 35549

Aortoiliofemoral

Deletion of codes 35551, 35651

Aortofermoral

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Moderate sedation symbols have been

added to 36200, 36245-36248

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Cardiovascular SystemNew codes added for renal catheterization and

angiography

• 36251Selective catheter placement (first-order), main

renal artery and any accessory renal artery(s) for renal

angiography, including arterial puncture and catheter

placement(s), fluoroscopy, contrast injection(s), image

postprocessing, permanent recording of images, and

radiological supervision and interpretation, including

pressure gradient measurements when performed, and

flush aortogram when performed; unilateral

• 36252 bilateral

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• 36253 Superselective catheter placement (one or more

second order or higher renal artery branches) renal

artery and any accessory renal artery(s) for renal

angiography, including arterial puncture, catheterization,

fluoroscopy, contrast injection(s), image postprocessing,

permanent recording of images, and radiological

supervision and interpretation, including pressure

gradient measurements when performed, and flush

aortogram when performed; unilateral

• 36254 bilateral

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Intravascular Vena Cava Filter

• 37191 Insertion of intravascular vena cava filter,

endovascular approach including vascular access,

vessel selection, and radiological supervision and

interpretation, intraprocedural roadmapping, and imaging

guidance (ultrasound and fluoroscopy), when performed

• 37192 Repositioning of intravascular vena cava filter,

endovascular approach including vascular access,




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Intravascular Vena Cava Filter

• 37193 Retrieval (removal) of intravascular vena cava

filter, endovascular approach including vascular access,




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Ligation

Deletion of code 37620

• 37619 Ligation of inferior vena cava

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Bone Marrow Harvesting

• 38232 Bone marrow harvesting for

transplantation; autologous

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Digestive System

47000 revised to include moderate sedation

49080 and 49081 were deleted and replaced with three

new codes:

– 49082 Abdominal paracentesis (diagnostic or therapeutic);

without imaging guidance

– 49083 Abdominal paracentesis (diagnostic or therapeutic); with

imaging guidance

– 49084 Peritoneal lavage, including imaging guidance, when

performed

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Nervous System

• Coding guidelines updated for Injection,

Drainage or Aspiration

– Fluoroscopy can be reported separately when

used for placement of injections with 62310-

62319

– Proper use of 62310-62311 and 62318-62319

– Indirect visualization

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Nervous System

Reservoir/Pump Implantation

– Revision was made to 62367

– Two new codes:

• 62369 Electronic analysis of programmable, implanted pump for

intrathecal or epidural drug infusion (includes evaluation of

reservoir status, alarm status, drug prescription status); with

reprogramming and refill

• 62370 Electronic analysis of programmable, implanted pump for

intrathecal or epidural drug infusion (includes evaluation of

reservoir status, alarm status, drug prescription status); with

reprogramming and refill (requiring physician’s skill)

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Nervous System

Laminotomy

– Revision for open procedures 63020-63035

– Percutaneous endoscopic approach reported

with 0274T-0275T

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Nervous System

Neurostimulators

Revisions to codes 64553, 64555, 64561,

64565, 64575, 64580, 64581, 64585 to

include “array”

Deletion of 64560 and 64577

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Nervous SystemDestruction by Neurolytic Agent

Revision to Coding Guidelines

Codes 64622-64627 deleted and replaced with four new codes:

● # 64633 Destruction by neurolytic agent, paravertebral facet joint

nerve(s), with imaging guidance (fluoroscopy or ct); cervical or

thoracic, single facet joint

● # +64634 each additional facet joint (List separately in addition to

code for primary procedure)

● # 64635 Destruction by neurolytic agent, paravertebral facet joint

nerve(s), with imaging guidance (fluoroscopy or ct); lumbar or

sacral, single facet joint

● # +64636 each additional facet joint (List separately in addition to

code for primary procedure)

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Auditory System

Code 69802 was deleted

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Radiology

Head and Neck

Code 70355 was revised to include (eg

panoramic X-ray)

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Radiology

Chest

Deletion of 71090. Report with 33206-33249

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Radiology

Spine and Pelvis

Revision of Lumbosacral Spine X-rays

▲ 72114 Radiologic examination, spine,

lumbosacral; complete, including bending views,

minimum of 6 views

▲ 72120 Radiologic examination, spine,

lumbosacral; bending views only, 2 or 3 views

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Radiology

Lower Extremities

Deletion of 73542. Radiology service

included with 27096

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Radiology

Abdomen

• 74174 Computed tomographic

angiography, abdomen and pelvis, with

contrast material(s), including noncontrast

images, if performed, and image

postprocessing

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Radiology

Angiography

Deletion of 75722 and 75724. Report with

36251, 36253 and 36252, 36254

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Radiology

Transcatheter Procedures

Deletion of 75940. Report with 37191

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Radiology

Transcatheter Procedures

Revisions to 75962, 75964

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Radiology

Fluoroscopic guidance

Revision to 77003

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Radiology

Bone/Joint Studies


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Radiology

Radiation Treatment Management and Delivery

Three new codes added:

● # 77424 Intraoperative radiation treatment

delivery, x-ray, single treatment session


delivery, electrons, single treatment session


management

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Radiology

Gastrointestinal System

Deleted 78220 and 78223

Two new codes

● 78226 Hepatobiliary system imaging, including

gallbladder when present;

● 78227 with pharmacologic intervention, including

quantitative measurement(s) when performed

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RadiologyNuclear Medicine-Respiratory System

Revised: One code

Deleted: Nine codes

New: Four codes

• 78579 Pulmonary ventilation imaging (eg, aerosol or gas)

• 78582 Pulmonary ventilation (eg, aerosol or gas) and perfusion

imaging

• 78597 Quantitative differential pulmonary perfusion, including

imaging when performed

• 78598 Quantitative differential pulmonary perfusion and ventilation

(eg, aerosol or gas), including imaging when performed

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Laboratory and Pathology

Molecular Pathology

New Section

Review all guidelines and definitions

Tier 1 Molecular Pathology Procedures

Tier 2 Molecular Pathology Procedures

Total of 101 new codes

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Medicine

Vaccination administration

Revised codes 90460 and 90461

Example: Admin codes for DTaP and

MMR

90460 x 2, 90461 x 4


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Medicine

Therapeutic repetitive transcranial magnetic

stimulation (TMS)

90867 Reported for the initial service

90868 Reported for the subsequent

services

90869 Added to report subsequent motor

threshold determination

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Medicine

Special Ophthalmological Services

Deletion of 92070. Replaced with two new codes:

● 92071 Fitting of contact lens for treatment of ocular

surface disease

● 92072 Fitting of contact lens for management of

keratoconus, initial fitting

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Medicine

Special Ophthalmological Services

Codes 92120 and 92130 were deleted

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Medicine

Audiology Function Tests

● # 92558 Evoked otoacoustic emissions, screening

(qualitative measurement of distortion product or

transient evoked otoacoustic emissions), automated

analysis

Revised 92587 and 92588

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Medicine

Evaluative and Therapeutic Services

Revision to code 92605 and new code

92618 report the time of the service and

that the service must be face to face with

the patient

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Medicine

Pulmonary Diagnostic Testing and

Therapies (94010-94799)

Revisions to guidelines

Codes were deleted and created in this

section to properly pulmonary testing and

therapy

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Medicine

• Codes 95970-+95975 have undergone

minor descriptor revisions to clarify their

use.

• Codes 95990-95991 have been revised to

include electronic analysis of the pump

when performed.

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Medicine

• 96367 revised to include it is a sequential

infusion of a new drug/substance

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Category II Codes

Category II codes are supplemental tracking

codes that can be used for performance

measurement under Medicare’s Physician

Quality Reporting System (PQRS) or private

payer pay-for-performance programs. Use of

Category II codes is optional; they are not tied to

a fee schedule and are intended for data

collection regarding quality of care.

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Category II Codes

For 2012, CPT® has added 59 new Category II

codes, revised five codes, and deleted one

code. For additional information on these codes,

consult your CPT® manual or the AMA website

at: http://www.ama-assn.org/go/cpt. You will find

a dedicated link for Category II codes to the right

of the screen, under the “Related Links” menu.

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Category III Codes

Category III codes describe emerging technologies and,

unlike Category I “unlisted procedure” codes, allow for

tracking and collection of specific data. If a Category III

code is available, it must be reported instead of a

Category I unlisted procedure code. Category III codes

have a five-year life span: Per CPT® guidelines, if a

Category III code is not replaced by a Category I code

(or otherwise revised) within five years, the Category III

code will be archived “unless it is demonstrated that a

temporary code is still needed.”

Complete2012 ProcedureCoding Updates & Rationales

ISBN 978-1-937348-03-8CPT® is a registered trademark of American Medical Association

AAPC2480 South 3850 West, Suite BSalt Lake City, Utah 84120800-626-CODE (2633), Fax 801-236-2258www.aapc.com

Complete 2012Procedure

Coding Updates

ii = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

DisclaimerThis course was current when it was published. Every reasonable effort has been made to assure the accuracy of the informa-tion within these pages. Readers are responsible to ensure they are using the codes, and following applicable guidelines, cor-rectly. AAPC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of information is error-free, and will bear no responsibility or liability for the results or consequences of the use of this course. This guide is a general summary that explains guidelines and principles in profitable, efficient health care organizations.

US Government RightsThis product includes CPT®, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995), as applicable, for U.S. Depart¬ment of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provision of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

AMA DisclaimerCPT® copyright 2011 American Medical Association. All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommendation their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not con¬tained herein.

CPT® is a registered trademark of the American Medical Association.

Written by G.J. Verhovshek, MA, CPC and Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC

© 2011 AAPC

2480 South 3850 West, Suite B, Salt Lake City, Utah 84120

800-626-CODE (2633), Fax 801-236-2258, www.aapc.com

All rights reserved.

Complete 2012 Procedure Updates 1 = FDA Approval Pending + = Add-on ○ = Reinstated/Recycled Code (Category III only)

IntroductionAs technology and clinical knowledge evolve, so does medi-cine. Health care also operates within a complex and ever-changing regulatory environment. To keep pace, the code sets we use to report medical services, procedures, devices, and drugs must be updated regularly.

Each November, the American Medical Association releases a revised CPT® code set for implementation the following January 1. At AAPC, our goal is to provide you with vital information to make the implementation process easier. This workbook summarizes significant CPT® 2012 code changes available at press time. Additional changes released sub-

sequently, as addenda or errata, will be posted on AAPC’s website (www.aapc.com).

CPT® 2012 contains revised section guidelines, parenthetical references, and appendices. This guide primarily summa-rizes changes, deletions, and revisions to the codes and code descriptors, with a brief rationale describing these changes. Minor changes in grammar or spelling that do not affect code use may be omitted. This guide does not review in full all instructional or text revisions within CPT®, and is not meant as a replacement for the complete 2012 CPT® coding manual. Always use the most current version of CPT®, and carefully follow all CPT® section guidelines, parenthetical references, and other instruction when assigning codes.

Checklist for Updating Your Codes Begin reviewing 2012 CPT® code changes, using this guide

Order 2012 code books

Review all changes to guidelines, notes, and instruc-tions in your book

Highlight changes in the book’s index pertinent to your specialty, and review those changes

Highlight changes in the book’s tabular (numeric) section pertinent to your specialty, and review those changes

Create a documentation “cheat sheet” of 2012 updates that must be documented differently for coders to capture the information needed and dis-tribute it to clinicians

Review and update superbills, chargemasters, etc.

Upload software change

Train coding and billing staff on changes

Check regularly for addenda or errata to the 2012 code set; if addenda are issued, communicate the contents to coding and clinical staff

Review physician quality reporting system (PQRS) changes, if you are participating in PQRS, and educate providers/make adjustments in processes to accommodate the new reporting measures

Communicate with payer/provider reps regarding reimbursement and coverage issues

Archive last year’s books within three months of the new code implementation dates

Significant Changes to CPT® for 2012Section GuidelinesCPT® 2012 includes minor changes to the evaluation and management (E/M) guidelines to clarify the meaning of “new” vs. “established” patients. New language stresses, “Solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by a physician and reported by a specific CPT® code(s). A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspe-cialty who belongs to the same group practice, within the past three years.”

CPT 2012® also re-establishes the “New vs. Established Patient” Decision Tree that was included in CPT® 2010, but was left out in 2011.

There are no changes to the Anesthesia, Surgery, or Medicine section guidelines to CPT® 2012.

ModifiersCPT® Appendix A adds two modifiers: 33 and 92.

Modifier 33 Preventive services has been effective since Jan. 1, 2011 but appears in CPT® for the first time. The modi-fier should be appended when reporting preventive services delivered “in accordance with a US Preventive Services Task Force A or B rating in effect” and “other preventive services identified in [legislative or regulatory] preventive services mandates.” Examples include the Medicare Initial Preventive

Procedure

2 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Physical Exam (G0402) and Annual Wellness Visits (G0438 and G0439).

You should not apply modifier 33 for separately reported services specifically identified as preventive (such as screen-ing mammography, 77057; screening colonoscopy, G0105 or G0121; or prostate screening with PSA, G0103). If the physi-cian converts a screening colonoscopy to a diagnostic colonos-copy (eg, 45385), you should append modifier PT Colorectal screening test converted to diagnostic test or other procedure—rather than modifier 33—to the diagnostic colonoscopy code to indicate that the procedure began as a preventive service.

Modifier 92 Alternative laboratory platform testing should be appended when:

• A laboratory test is performed using a kit or transport-able instrument that wholly or in part consists of a single use, disposable, analytical chamber;

• the test does not require permanent dedicated space; and,

• the test is designed to be carried or transported to the vicinity of the patient for immediate testing at that site.

For Medicare payers, modifier 92 indicates point-of-service HIV testing (86701–86703 and 87389) only. Per CMS trans-mittal 2277 (www.cms.gov/transmittals/downloads/R2277CP.pdf), the modifier is effective Oct. 1, 2011 for this purpose. Modifier 92 was introduced in CPT® 2008, and Medicare will allow you to apply the modifier retroactively to claims filed on or since Jan. 1, 2008.

Genetic testing code modifiers are covered separately in CPT® Appendix I.

Evaluation and Management ServicesInitial Observation Care 99218 Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: a detailed or comprehensive history; a detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission to “observation status” are of low sever-ity. Physicians typically spend 30 minutes at the bedside and on the patient’s hospital floor or unit.

AAPC Rationale “Reference times” have been added to initial observation care codes 99218, 99219, and 99220, based on a crosswalk from the Hospital Inpatient Services Codes. The new language allows physicians to report the initial observation care codes using time as the key component, when counseling or coor-dination of care dominates the encounter.

Initial Observation Care 99219 Initial observation care, per day, for the evalua-tion and management of a patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate com-plexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission to “observation status” are of moderate severity. Physicians typically spend 50 minutes at the bedside and on the patient’s hospital floor or unit.

AAPC Rationale“Reference times” have been added to initial observation care codes 99218, 99219, and 99220, based on a crosswalk from the Hospital Inpatient Services Codes. The new language allows physicians to report the initial observation care codes using time as the key component, when counseling or coor-dination of care dominates the encounter.

Initial Observation Care 99220 Initial observation care, per day, for the evalua-tion and management of a patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of high com-plexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission to “observation status” are of high severity. Physicians typically spend 70 minutes at the bedside and on the patient’s hospital floor or unit.

AAPC Rationale“Reference times” have been added to initial observation care codes 99218, 99219, and 99220, based on a crosswalk from the Hospital Inpatient Services Codes. The new language allows physicians to report the initial observation care codes using time as the key component, when counseling or coordination of care dominates the encounter.

Procedure


Prolonged Service With Direct Patient Contact +99354 Prolonged physician service in the office or other outpatient setting requiring direct patient (face to face) con-tact beyond the usual service; first hour (List separately in addition to code for office or other outpatient evaluation and management service)

AAPC RationaleWith the addition of new guidelines better defining the meaning of “direct patient contact,” the term “face-to-face” has been deleted from Prolonged Services codes 99354–99359. Codes 99354–99357 also delete the term “physician” to allow reporting by other qualified health care professionals.

Prolonged Service With Direct Patient Contact +99355 Prolonged physician service in the office or other outpatient setting requiring direct patient (face to face) con-tact beyond the usual service; each additional 30 minutes (List separately in addition to code for prolonged physician service)

AAPC RationaleWith the addition of new guidelines better defining the meaning of “direct patient contact,” the term “face-to-face” has been deleted from Prolonged Services codes 99354–99359. Codes 99354–99357 also delete the term “physician” to allow reporting by other qualified health care professionals.

Prolonged Service With Direct Patient Contact +99356 Prolonged physician service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient evaluation and management service)

AAPC RationaleWith the addition of new guidelines better defining the meaning of “direct patient contact,” the term “face-to-face” has been deleted from Prolonged Services codes 99354–99359. Codes 99354–99357 also delete the term “physician” to allow reporting by other qualified health care profession-als. Codes 99356 and 99357 may also now be used in the observation setting.

Prolonged Service With Direct Patient Contact +99357 Prolonged physician service in the inpatient or observation setting, requiring unit/floor time beyond the

usual service; each additional 30 minutes (List separately in addition to code for prolonged physician service)

AAPC RationaleWith the addition of new guidelines better defining the meaning of “direct patient contact,” the term “face-to-face” has been deleted from Prolonged Services codes 99354–99359. Codes 99354–99357 also delete the term “physician” to allow reporting by other qualified health care profession-als. Codes 99356 and 99357 may also now be used in the observation setting.

Prolonged Service Without Direct Patient Contact +99358 Prolonged evaluation and management service before and/or after direct (face to face) patient care; first hour

AAPC RationaleWith the addition of new guidelines better defining the meaning of “direct patient contact,” the term “face-to-face” has been deleted from Prolonged Services codes 99354–99359. Guideline revisions also allow use of 99358–99359 by qualified health care professionals other than physicians.

Prolonged Service Without Direct Patient Contact +99359 Prolonged evaluation and management service before and/or after direct (face to face) patient care; each additional 30 minutes (List separately in addition to code for prolonged physician service)

AAPC RationaleWith the addition of new guidelines better defining the meaning of “direct patient contact,” the term “face-to-face” has been deleted from Prolonged Services codes 99354–99359. Guideline revisions also allow use of 99358–99359 by qualified health care professionals other than physicians.

SurgeryIntegumentary System/Introduction11975 Insertion, implantable contraceptive capsules

AAPC RationaleCode 11975 has been deleted; to report insertion of non-biodegradable drug delivery implant for contraception, use 11981 Insertion, non-biodegradable drug delivery implant.

Procedure


Integumentary System/Introduction11977 Removal with reinsertion, implantable contraceptive capsules

AAPC RationaleCode 11977 has been deleted; to report removal of implant-able contraceptive capsules with subsequent insertion of non-biodegradable drug delivery implant, use 11976 Removal, implantable contraceptive capsules and 11981 Insertion, non-biode-gradable drug delivery implant.

Integumentary System/Skin Replacement Surgery and Skin Substitutes 15150 Tissue cultured epidermal skin autograft, trunk, arms, legs; first 25 sq cm or less

AAPC RationaleDescriptor language for codes 15150–15157 has been revised (deleting “epidermal” and replacing it with “skin”) for consistency.

Integumentary System/Skin Replacement Surgery and Skin Substitutes +15151 Tissue cultured epidermal skin autograft, trunk, arms, legs; additional 1 sq cm to 75 sq cm (List separately in addition to code for primary procedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutes +15152 Tissue cultured epidermal skin autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutes 15155 Tissue cultured epidermal skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less


Integumentary System/Skin Replacement Surgery and Skin Substitutes +15156 Tissue cultured epidermal skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; additional 1 sq cm to 75 sq cm (List separately in addition to code for primary procedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutes +15157 Tissue cultured epidermal skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutes15170 Acellular dermal replacement, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

AAPC RationaleCodes 15170–15176 have been deleted; see new codes 15271–15278.

Procedure


Integumentary System/Skin Replacement Surgery and Skin Substitutes15171 Acellular dermal replacement, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addi-tion to code for primary procedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutes15175 Acellular dermal replacement, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or mul-tiple digits; first 100 sq cm or less, or 1% of body area of infants and children


Integumentary System/Skin Replacement Surgery and Skin Substitutes15176 Acellular dermal replacement, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or mul-tiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutesl 15271 Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

AAPC RationaleCode 15271 is one of eight new codes to describe skin graft application, to replace deleted codes 15170–15176 and 15300–15431. The new code set describes such grafts by location and area, rather than by product description (eg, “acellular dermal replacement”).

Codes 15271 (first 25 sq. cm.) and add-on 15272 (each addi-tional 25 sq. cm.) apply to the areas of trunk, arms, and legs for wounds of less than 100 sq. cm. For wounds in the same areas of greater than 100 sq. cm., see 15273–15274.

Supply of the skin substitute is reported separately.

Integumentary System/Skin Replacement Surgery and Skin Substitutesl +15272 Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)


Codes 15271 (first 25 sq. cm.) and add-on 15272 (each addi-tional 25 sq. cm.) apply to the areas of trunk, arms, and legs for wounds of less than 100 sq. cm. For wounds in the same areas of greater than 100 sq. cm., see 15273–15274.


Integumentary System/Skin Replacement Surgery and Skin Substitutesl 15273 Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children


Codes 15273 (first 100 sq. cm.) and add-on 15274 (each additional 100 sq. cm.) apply to the areas of trunk, arms, and legs for wounds equal to or greater than 100 sq. cm. For wounds in the same areas of less than 100 sq. cm., see 15271–15272.


Procedure


Integumentary System/Skin Replacement Surgery and Skin Substitutesl +15274 Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)


Codes 15273 (first 100 sq. cm.) and add-on 15274 (each additional 100 sq. cm.) apply to the areas of trunk, arms, and legs for wounds equal to or greater than 100 sq. cm. For wounds in the same areas of less than 100 sq. cm., see 15271–15272.


Integumentary System/Skin Replacement Surgery and Skin Substitutesl 15275 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area


Codes 15275 (first 25 sq. cm.) and add-on 15276 (each addi-tional 25 sq. cm.) apply to the areas of face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or mul-tiple digits for wounds less than 100 sq. cm. For wounds in the same areas equal to or greater than 100 sq. cm., see 15277–15278.


Integumentary System/Skin Replacement Surgery and Skin Substitutesl +15276 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)


Codes 15275 (first 25 sq. cm.) and add-on 15276 (each addi-tional 25 sq. cm.) apply to the areas of face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or mul-tiple digits for wounds less than 100 sq. cm. For wounds in the same areas equal to or greater than 100 sq. cm., see 15277–15278.


Integumentary System/Skin Replacement Surgery and Skin Substitutesl 15277 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, 1% of body area of infants and children, or part thereof


Codes 15277 (first 100 sq. cm.) and add-on 15278 (each addi-tional 100 sq. cm.) apply to the areas of face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or mul-tiple digits for wounds equal to or greater than 100 sq. cm. For wounds in the same areas of less than 100 sq. cm., see 15275–15276.


Procedure


Integumentary System/Skin Replacement Surgery and Skin Substitutesl +15278 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound sur-face area, or part thereof


Codes 15277 (first 100 sq. cm.) and add-on 15278 (each addi-tional 100 sq. cm.) apply to the areas of face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or mul-tiple digits for wounds equal to or greater than 100 sq. cm. For wounds in the same areas of less than 100 sq. cm., see 15275–15276.


Integumentary System/Skin Replacement Surgery and Skin Substitutes15300 Allograft skin for temporary wound closure, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children


Integumentary System/Skin Replacement Surgery and Skin Substitutes15301 Allograft skin for temporary wound closure, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutes15320 Allograft skin for temporary wound closure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children


Integumentary System/Skin Replacement Surgery and Skin Substitutes15321 Allograft skin for temporary wound closure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutes15330 Acellular dermal allograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children


Integumentary System/Skin Replacement Surgery and Skin Substitutes15331 Acellular dermal allograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addi-tion to code for primary procedure)


Procedure


Integumentary System/Skin Replacement Surgery and Skin Substitutes15335 Acellular dermal allograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children


Integumentary System/Skin Replacement Surgery and Skin Substitutes15336 Acellular dermal allograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List sepa-rately in addition to code for primary procedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutes15340 Tissue cultured allogeneic skin substitute; first 25 sq cm or less


Integumentary System/Skin Replacement Surgery and Skin Substitutes15341 Tissue cultured allogeneic skin substitute; each addi-tional 25 sq cm, or part thereof (List separately in addition to code for primary procedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutes15360 Tissue cultured allogeneic dermal substitute, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children


Integumentary System/Skin Replacement Surgery and Skin Substitutes15361 Tissue cultured allogeneic dermal substitute, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutes15365 Tissue cultured allogeneic dermal substitute, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children


Integumentary System/Skin Replacement Surgery and Skin Substitutes15366 Tissue cultured allogeneic dermal substitute, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)


Procedure


Integumentary System/Skin Replacement Surgery and Skin Substitutes15400 Xenograft, skin (dermal), for temporary wound clo-sure, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children


Integumentary System/Skin Replacement Surgery and Skin Substitutes15401 Xenograft, skin (dermal), for temporary wound clo-sure, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary pro-cedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutes15420 Xenograft skin (dermal), for temporary wound clo-sure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children


Integumentary System/Skin Replacement Surgery and Skin Substitutes15421 Xenograft skin (dermal), for temporary wound clo-sure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and chil-dren, or part thereof (List separately in addition to code for primary procedure)


Integumentary System/Skin Replacement Surgery and Skin Substitutes15430 Acellular xenograft implant; first 100 sq cm or less, or 1% of body area of infants and children


Integumentary System/Skin Replacement Surgery and Skin Substitutes15431 Acellular xenograft implant; each additional 100 sq cm, or each additional 1% of body area of infants and chil-dren, or part thereof (List separately in addition to code for primary procedure)


Integumentary System/Other Flaps and Graftsl +15777 Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (eg, breast, trunk) (List separately in addition to code for primary pro-cedure)

AAPC RationaleAdd-on 15777 is new to describe implantation of biologic implant (eg, FlexHD®) for soft tissue reinforcement (for example, during breast reconstruction following mastec-tomy—for bilateral breast reconstruction append modifier 50 Bilateral procedure). Report supply of the implant separately.

Musculoskeletal/Introduction or Removall 20527 Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren’s contracture)

AAPC RationaleNew code 20527 specifically describes injection of an enzyme to treat Dupuytren’s contracture, a thickening and tighten-ing (contracture) of this fibrous tissue that can cause the fingers to curl. An injection of corticosteroid may help pre-vent the progression of contracture. Several injections may be needed for a lasting effect.

Procedure


For manipulation of the palmer fascial cord following the injection, see new code 26341 Manipulation, palmar fascial cord (ie, Dupuytren’s cord), post enzyme injection (eg, collagenase), single cord.

Musculoskeletal/Vertebral Body, Embolization or Injection 22520 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic

AAPC RationaleBone biopsy, when performed, is now expressly bundled into percutaneous vertebroplasty; descriptor language for 22520–22522 is now consistent with kyphoplasty codes 22523–22525. The national Correct Coding Initiative (CCI) has bundled bone biopsy to these procedures for several years.

Musculoskeletal/Vertebral Body, Embolization or Injection 22521 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; lumbar


Musculoskeletal/Vertebral Body, Embolization or Injection +22522 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar ver-tebral body (List separately in addition to code for primary procedure)


Musculoskeletal/Arthrodesis 22610 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with or without lateral transverse tech-nique, when performed)

AAPC RationaleDescriptor language for 22610 has been revised for clarity and consistency. There is no change in code application from previous years.

Musculoskeletal/Arthrodesis 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with or without lateral transverse tech-nique, when performed)

AAPC RationaleDescriptor language for 22612 has been revised for clarity and consistency. There is no change in code application from previous years.

Musculoskeletal/Arthrodesisl 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare inter-space (other than for decompression), single interspace and segment; lumbar

AAPC RationaleNew lumbar arthrodesis code 22633 (and add-on 22634) describes a combined posterior/posterolateral technique with a posterior interbody approach, including minimal laminec-tomy and/or discectomy to prepare the interspace. Report 22633 for the first interspace treated and 22634 for each additional interspace.

Do not report 22633 at the same level as 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lat-eral transverse technique, when performed).

Musculoskeletal/Arthrodesisl +22634 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare inter-space (other than for decompression), single interspace and segment; each additional interspace

AAPC RationaleNew lumbar arthrodesis code 22633 (and add-on 22634) describes a combined posterior/posterolateral technique with

Procedure


a posterior interbody approach, including minimal laminec-tomy and/or discectomy to prepare the interspace. Report 22633 for the first interspace treated and 22634 for each additional interspace.

Musculoskeletal System/Repair, Revision, and/or Reconstructionl 26341 Manipulation, palmar fascial cord (ie, Dupuytren’s cord), post enzyme injection (eg, collagenase), single cord

AAPC RationaleNew code 26341 describes manipulation of the palmer fas-cial cord, following injection of an enzyme to treat Dupuy-tren’s contracture as reported with 20527 Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren’s contracture). Dupuytren’s contracture is a thickening and tightening (con-tracture) of this fibrous tissue that can cause the fingers to curl. An injection of corticosteroid, followed by manipula-tion, may help to prevent progression of contracture.

Musculoskeletal System/Introduction or removal 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed

AAPC RationaleCode 27096 has been revised to specifically include image guidance by fluoroscopy or computed tomography (CT) to confirm intra-articular needle positioning. Arthrography also is included, when performed. For bilateral procedures, append modifier 50 Bilateral procedure.

If sacroiliac joint injection does not include fluoroscopy or CT guidance, report 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) rather than 27096.

Musculoskeletal System/Lower Extremity/Strapping 29581 Application of multi-layer venous wound compres-sion system, below knee; leg (below knee), including ankle and foot

AAPC RationaleDescriptor language for 29581 has been revised to provide consistency with new codes 29582–29584. Compression

helps to circulate blood (for instance, in diabetic patients), thus leading to improved healing.

The compression codes are reported according to the areas treated; 29581 applies to below knee systems, including ankle and foot. For above knee systems, see 29582 Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed.

Do not report 29581 with strapping procedures 29540 (ankle and/or foot) or 29580 (Unna boot); 29582; ablation proce-dures 36475 and 36478; or manual therapy 97140.

Musculoskeletal System/Lower Extremity/Strappingl 29582 Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed

AAPC RationaleNew and revised compression codes (29581–29584) are reported according to the areas treated; 29582 applies to thigh and leg systems, including ankle and foot. For below knee systems, see 29581 Application of multi-layer compression system; leg (below knee), including ankle and foot.

Do not report 29582 with strapping procedures 29540 (ankle and/or foot) or 29580 (Unna boot); 29581; ablation procedures 36475 and 36478; or manual therapy 97140.

Compression helps to circulate blood (for instance, in dia-betic patients), thus leading to improved healing.

Musculoskeletal System/Lower Extremity/Strappingl 29583 Application of multi-layer compression system; upper arm and forearm

AAPC RationaleNew and revised compression codes (29581–29584) are reported according to the areas treated; 29583 applies to upper arm and forearm systems. For upper arm and forearm with hand and fingers, see 29584 Application of multi-layer compression system; upper arm, forearm, hand, and fingers. Com-pression helps to circulate blood (for instance, in diabetic patients), thus leading to improved healing.

Do not report 29583 with 29584 or manual therapy, 97140.

Procedure


Musculoskeletal System/Lower Extremity/Strappingl 29584 Application of multi-layer compression system; upper arm, forearm, hand, and fingers

AAPC RationaleNew and revised compression codes (29581–29584) are reported according to the areas treated; 29584 applies to upper arm and forearm systems, including hand and fin-gers. For upper arm and forearm without hand and fingers, see 29583 Application of multi-layer compression system; upper arm and forearm. Compression helps to circulate blood (for instance, in diabetic patients), thus leading to improved healing.

Do not report 29584 with 29583 or manual therapy, 97140.

Musculoskeletal System/Endoscopy-Arthroscopy +29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoac-romial or without ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure)

AAPC RationaleAccording to the AMA, 29826 is billed more than 95 per-cent of the time in addition to other arthroscopic repair; for that reason, 29826 has become an add-on code for 2012. Primary arthroscopic repairs that 29826 may accompany include: 29806–29825 and 29827–29828.

Musculoskeletal System/Endoscopy-Arthroscopy 29880 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chon-droplasty), same or separate compartment(s), when performed

AAPC RationaleAccording to the AMA, chondroplasty is typically performed with knee arthroscopy; therefore, chondroplasty has been added as an included component of surgical arthroscopy codes 29880 medial AND lateral meniscectomy and 29881 medial OR lateral meniscectomy.

Musculoskeletal System/Endoscopy-Arthroscopy 29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) includ-ing debridement/shaving of articular cartilage (chondro-plasty), same or separate compartment(s), when performed

AAPC RationaleAccording to the AMA, chondroplasty is typically performed with knee arthroscopy; therefore, chondroplasty has been added as an included component of surgical arthroscopy codes 29881 medial OR lateral meniscectomy and 29880 medial AND lateral meniscectomy.

Respiratory System/Incision32095 Thoracotomy, limited, for biopsy of lung or pleura

AAPC RationaleCode 32095 has been deleted; see new codes 32096–32098.

Respiratory System/Incisionl 32096 Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral

AAPC RationaleCode 32096 is one of three new codes created to provide more detail for the type of tissue biopsied during a thoracot-omy. The procedure is reported once per lung, regardless of the number of biopsies performed. When performed on both lungs, append modifier 50 Bilateral procedure.

Respiratory System/Incisionl 32097 Thoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral

AAPC RationaleCode 32097 is one of three new codes created to provide more detail for the type of tissue biopsied during a thoracot-omy. The procedure is reported once per lung, regardless of the number of biopsies performed. When performed on both lungs, append modifier 50 Bilateral procedure.

Respiratory System/Incisionl 32098 Thoracotomy, with biopsy(ies) of pleura

Procedure


AAPC RationaleCode 32098 is one of three new codes created to provide more detail for the type of tissue biopsied during a thora-cotomy. The procedure is reported once, regardless of the number of biopsies performed.

Respiratory System/Incision 32100 Thoracotomy, major; with exploration and biopsy

AAPC RationaleDescriptor language for 32100–32160 has been revised (deleting “major”) for consistency. Code 32100 was also revised to remove “and biopsy;” to report biopsy(ies) per-formed by thoracotomy, see 32096–32098.

Respiratory System/Incision 32110 Thoracotomy, major; with control of traumatic hemorrhage and/or repair of lung tear

AAPC RationaleDescriptor language for 32100–32160 has been revised (deleting “major”) for consistency.

Respiratory System/Incision 32120 Thoracotomy, major; for postoperative complications


Respiratory System/Incision 32124 Thoracotomy, major; with open intrapleural pneu-monolysis


Respiratory System/Incision 32140 Thoracotomy, major; with cyst(s) removal, with or without a includes pleural procedure when performed

AAPC RationaleDescriptor language for 32100–32160 has been revised (deleting “major”) for consistency; 32140 was further revised to include the inclusion of pleural procedures, when performed.

Respiratory System/Incision 32141 Thoracotomy, major; with excision resection-pli-cation of bullae, with or without includes any pleural proce-dure when performed

AAPC RationaleDescriptor language for 32100–32160 has been revised (deleting “major”) for consistency. 32141 was further revised to include the inclusion of pleural procedures, when per-formed.

Respiratory System/Incision 32150 Thoracotomy, major; with removal of intrapleural foreign body or fibrin deposit

AAPC RationaleDescriptor language for codes 32100–32160 has been revised (deleting “major”) for consistency.

Respiratory System/Incision 32151 Thoracotomy, major; with removal of intrapulmo-nary foreign body


Respiratory System/Incision 32160 Thoracotomy, major; with cardiac massage


Respiratory System/Excision32402 Biopsy, pleura; open

AAPC RationaleCode 32402 has been deleted; see new code 32098.

Respiratory System/Excision 32405 Biopsy, lung or mediastinum, percutaneous needle

AAPC RationaleBiopsy of lung, as described by 32405, now includes moderate sedation, when performed.

Procedure


Respiratory System/Removal 32440 Removal of lung, total pneumonectomy;

AAPC RationaleDescriptor language for 32440–32445 and 32480–32491 has been revised (deleting “total”) for consistency with new codes created for lung excisions.

Respiratory System/Removal 32442 Removal of lung, total pneumonectomy; with resection of segment of trachea followed by broncho-tracheal anastomosis (sleeve pneumonectomy)


Respiratory System/Removal 32445 Removal of lung, total pneumonectomy; extrapleu-ral


Respiratory System/Removal 32480 Removal of lung, other than total pneumonec-tomy; single lobe (lobectomy)


Respiratory System/Removal 32482 Removal of lung, other than total pneumonectomy; 2 lobes (bilobectomy)


Respiratory System/Removal 32484 Removal of lung, other than total pneumonectomy; single segment (segmentectomy)


Respiratory System/Removal 32486 Removal of lung, other than total pneumonectomy; with circumferential resection of segment of bronchus followed by broncho-bronchial anastomosis (sleeve lobectomy)


Respiratory System/Removal 32488 Removal of lung, other than total pneumonec-tomy; with all remaining lung following previous removal of a portion of lung (completion pneumonectomy)


Respiratory System/Removal 32491 Removal of lung, other than total pneumonectomy; excision with resection-plication of emphysematous lung(s) (bullous or non-bullous) for lung volume reduction, sternal split or transthoracic approach with or without, includes any pleural procedure, when performed

AAPC RationaleDescriptor language for 32440–32445 and 32480–32491 has been revised (deleting “total”) for consistency with new codes created for lung excisions; 32491 was further revised to include pleural procedures, when performed.

Respiratory System/Removal32500 Removal of lung, other than total pneumonectomy; wedge resection, single or multiple

Procedure


AAPC RationaleCode 32500 has been deleted; see new codes 32505–32507.

Respiratory System/Removall 32505 Thoracotomy; with therapeutic wedge resection (eg, mass, nodule), initial

AAPC RationaleCode 32505 was created to report an initial therapeutic wedge resection performed via thoracotomy. Do report 32505 with lung removal procedures 32440, 32442, 32445, and 32488.

Respiratory System/Removall +32506 Thoracotomy; with therapeutic wedge resection (eg, mass or nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure)

AAPC RationaleCode 32506 is an add-on code created to report each addi-tional wedge resection. This code is to be used only with 32505.

Respiratory System/Removall +32507 Thoracotomy; with diagnostic wedge resection followed by anatomic lung resection (List separately in addi-tion to code for primary procedure)

AAPC RationaleCode 32507 is an add-one created to report a diagnostic wedge resection when performed with other procedures. In CPT®, a parenthetical note following 32507 lists the appropriate primary procedures as pneumonectomy (32440, 32442, 32445), other lung removal (32480, 32482, 32484, 32486, 32488), and bronchoplasty (32503, 32504).

Respiratory System/Endoscopy 32601 Thoracoscopy, diagnostic (separate procedure); lungs and, pericardial sac, mediastinal or pleural space, with-out biopsy

AAPC RationaleThe heading of subsection (32601–32674) was revised to accurately describe the techniques used during Video-assisted Thoracic Surgery (VATS). Code 32601 was revised to include the “pericardial sac, mediastinal or pleural space.”

This code is reported for a diagnostic VATS thoracoscopy, including biopsy.

Respiratory System/Endoscopy32602 Thoracoscopy, diagnostic (separate procedure); lungs and pleural space, with biopsy

AAPC RationaleCode 32602 has been deleted; see new codes 32607-32609.

Respiratory System/Endoscopy32603 Thoracoscopy, diagnostic (separate procedure); pericar-dial sac, without biopsy

AAPC RationaleCode 32603 has been deleted; see revised code 32601.

Respiratory System/Endoscopy32605 Thoracoscopy, diagnostic (separate procedure); medias-tinal space, without biopsy

AAPC RationaleCode 32605 has been deleted; see revised code 32601.

Respiratory System/Endoscopyl 32607 Thoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral

AAPC RationaleCode 32607 is one of three new codes created to provide more detail for the type of tissue biopsied during a VATS thoracoscopy. The procedure is reported once per lung, regardless of the number of biopsies performed.

Respiratory System/Endoscopyl 32608 Thoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral

AAPC RationaleCode 32608 is one of three new codes created to provide more detail for the type of tissue biopsied during a VATS thoracoscopy. The procedure is reported once per lung, regardless of the number of biopsies performed.

Procedure


Respiratory System/Endoscopyl 32609 Thoracoscopy; with biopsy(ies) of pleura

AAPC RationaleCode 32609 is one of three new codes created to provide more detail for the type of tissue biopsied during a VATS thoracoscopy. The procedure is reported once, regardless of the number of biopsies performed.

Respiratory System/Endoscopy 32655 Thoracoscopy, surgical; with excision resection-plication of bullae, including includes any pleural procedure when performed

AAPC RationaleDescriptor language for 32655 has been revised (chang-ing “excision” to “resection”) for consistency. The code also includes pleural procedures, when performed.

Respiratory System/Endoscopy32657 Thoracoscopy, surgical; with wedge resection of lung, single or multiple

AAPC RationaleCode 32657 has been deleted; see new codes 32666, 32667, 32668.

Respiratory System/Endoscopy32660 Thoracoscopy, surgical; with total pericardiectomy

AAPC RationaleCode 32660 was deleted because the procedure is no longer performed.

Respiratory System/Endoscopy 32663 Thoracoscopy, surgical; with lobectomy, total or segmental (single lobe)

AAPC RationaleDescriptor language for code 32663 has been revised (delet-ing “total”) for consistency with new codes created for lung excisions.

Respiratory System/Endoscopyl 32666 Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass, nodule), initial unilateral

AAPC RationaleCode 32666 was created to report an initial therapeutic wedge resection performed via VATS thoracoscopy. Do not to report 32666 with lung removal procedures 32440, 32442, 32445, 32488, and 32671.

Respiratory System/Endoscopyl +32667 Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass or nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure)

AAPC RationaleCode 32667 is an add-on created to report each additional wedge resection. Use 32667 only in addition to 32666.

Respiratory System/Endoscopyl +32668 Thoracoscopy, surgical; with diagnostic wedge resection followed by anatomic lung resection (List separately in addition to code for primary procedure)

AAPC RationaleCode 32668 is an add-one created to report a diagnostic wedge resection when performed with other procedures. Pri-mary procedures may include lung removal (32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488), tumor resec-tion (32503, 32504), and thorcoscopy with lobectomy, wedge resection, or removal of flung segment(s) (32663, 32669, 32670, 32671).

Respiratory System/Endoscopyl 32669 Thoracoscopy, surgical; with removal of a single lung segment (segmentectomy)

AAPC RationaleCodes 32669–32674 were created to report removal pro-cedures performed via VATS thoracoscopy. The codes are selected based on the type or amount of tissue removed, or the difficulty of the procedure.

Code 32669 is reported when a single lung segment is removed.

Respiratory System/Endoscopyl 32670 Thoracoscopy, surgical; with removal of two lobes (bilobectomy)

Procedure



Code 32670 is reported when two lobes are removed.

Respiratory System/Endoscopyl 32671 Thoracoscopy, surgical; with removal of lung (pneu-monectomy)


Code 32671 is reported when an entire lung is removed.

Respiratory System/Endoscopyl 32672 Thoracoscopy, surgical; with resection-plication for emphysematous lung (bullous or non-bullous) for lung volume reduction (LVRS), unilateral includes any pleural procedure, when performed


Code 32672 is reported for the resection of an emphysema-tous lung. This procedure includes procedures performed on the pleura.

Respiratory System/Endoscopyl 32673 Thoracoscopy, surgical; with resection of thymus, unilateral or bilateral


Code 32673 is reported for the resection of the thymus.

Respiratory System/Endoscopyl +32674 Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure)


Code 32674 is add-on for mediastinal and regional lymph-adenectomy when performed with another procedure. A par-enthetical note in CPT® lists primary procedure codes with which you may report 32674.

Cardiovascular System/Heart and Pericardium 33050 Excision Resection of pericardial cyst or tumor

AAPC RationaleCode 33050 was revised for consistency in coding excisions. Parenthetical notes were added to direct the coder to the proper codes when the procedure is performed via VATS.

Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial

AAPC RationaleDescriptor language for codes 33206–33208 has been revised (adding “new”) for consistency.

Coding guidelines for 33206–33249 have been revised to include radiologic supervision and interpretation. Fluoroscopy (76000) can be reported only when performed for diagnostic lead evaluation without lead insertion, replacement, or revisions.

Procedure


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33207 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular


Coding guidelines for 33206–33249 have been revised to include radiologic supervision and interpretation. Fluoros-copy (76000) can be reported only when performed for diag-nostic lead evaluation without lead insertion, replacement, or revisions.

Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33208 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular



Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33212 Insertion or replacement of pacemaker pulse generator only; single chamber, atrial or ventricular with existing single lead

AAPC RationaleDescriptor language for codes 33212–33213 has been revised (deleting “or replacement”) and adding the correct terminol-ogy for the type of lead.


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33213 Insertion or replacement of pacemaker pulse generator only; with existing dual chamber leads

AAPC RationaleDescriptor language for codes 33212–33213 has been revised (deleting “or replacement”) and adding the correct terminol-ogy for the type of lead.


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33218 Repair of single transvenous electrode for a single chamber, permanent pacemaker or single chamber pacing cardioverter-defibrillator

AAPC RationaleDescriptor language for code 33218 has been revised (delet-ing “single chamber”) for consistency with the terminology in this subsection.


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33220 Repair of 2 transvenous electrodes for a dual chamber permanent pacemaker or duel chamber pacing cardioverter-defibrillator

AAPC RationaleDescriptor language for code 33220 has been revised (delet-ing “dual chamber”) for consistency with the terminology in this subsection.


Procedure


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33224 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previ-ously placed pacemaker or pacing cardioverter-defibrillator pulse generator (including revision of pocket, removal, inser-tion, and/or replacement of existing generator)

AAPC RationaleDescriptor language for 33224 has been revised (adding “existing”) for consistency with the terminology in this sub-section.


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse genera-tor (including upgrade to dual chamber system and pocket revision) (List separately in addition to code for primary procedure)

AAPC RationaleDescriptor language for code 33225 has been revised (adding “and pocket revision”) to clarify that pocket revision is included and not reported separately.

Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillatorl # 33221 Insertion of pacemaker pulse generator only; with existing multiple leads

AAPC RationaleCode 33221 was created to report the insertion of pace-maker pulse generator using existing multiple leads.



Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33226 Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator)

AAPC RationaleDescriptor language for code 33226 has been revised (adding “existing”) for consistency with the terminology in this sub-section.


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33233 Removal of permanent pacemaker pulse generator only

AAPC RationaleDescriptor language for code 33233 has been revised (adding “only”) to clarify that only the pulse generator is removed.


Procedure


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillatorl # 33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system

AAPC RationaleThree new codes were created to include the removal and replacement of the pacemaker pulse generator; 33227 is reported for a single lead system. Do not report the removal of the pulse generator separately.

Coding guidelines for 33206–33249 have been revised to include radiologic supervision and interpretation. Fluo-roscopy (76000) can be reported only when performed for diagnostic lead evaluation without lead insertion, replace-ment, or revisions.

Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillatorl # 33228 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system

AAPC RationaleThree new codes were created to include the removal and replacement of the pacemaker pulse generator; 33228 is reported for a dual lead system. Do not report the removal of the pulse generator separately.


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillatorl # 33229 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system

AAPC RationaleThree new codes were created to include the removal and replacement of the pacemaker pulse generator; 33229 is reported for a multiple lead system. Do not report the removal of the pulse generator separately.


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33240 Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator only; with existing single lead

AAPC RationaleDescriptor language for 33240 has been revised (deleting “single or dual” and adding “only; with existing single lead”) for consistency. Prior to 2012, only one code was available to report the insertion of a pacing cardioverter-defibrillator pulse generator. The revision of 33240 was required to accommodate two new codes (33230, 33231) to report the procedure for dual and multiple leads systems.


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillatorl # 33230 Insertion of pacing cardioverter-defibrillator pulse generator only; with existing dual leads

AAPC RationaleCode 33240 has been revised and two new codes (33230, 33231) created to report the insertion of a pacing cardio-verter-defibrillator pulse generator using existing leads; 33230 is reported when the procedure involves a dual lead system.


Procedure


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillatorl # 33231 Insertion of pacing cardioverter-defibrillator pulse generator only; with existing multiple leads

AAPC RationaleCode 33240 has been revised and two new codes (33230, 33231) created to report the insertion of a pacing cardio-verter-defibrillator pulse generator using existing leads; 33231 is reported when the procedure involves a multiple lead system.


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33241 Subcutaneous removal Removal of single or dual chamber pacing cardioverter-defibrillator pulse genera-tor only

AAPC RationaleDescriptor language for code 33241 has been revised (delet-ing “Subcutaneous, single or dual chamber” and adding “only”) for consistency with the terminology in this subsec-tion; 33241 is reported for the removal of a pacing cardio-verter-defibrillator pulse generator for all three types of systems (single, dual, or multiple lead).


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillatorl # 33262 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; single lead system

AAPC RationaleThree new codes were created to report the removal and replacement of a pacing cardioverter-defibrillator pulse

generator. The code is selected based on the type of system; 33262 is reported for a single lead system. Do not report the removal of the pulse generator separately.


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillatorl # 33263 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; dual lead system

AAPC RationaleThree new codes were created to report the removal and replacement of a pacing cardioverter-defibrillator pulse generator. The code is selected based on the type of system; 33263 is reported for a dual lead system. Do not report the removal of the pulse generator separately.


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillatorl # 33264 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; multiple lead system

AAPC RationaleThree new codes were created to report the removal and replacement of a pacing cardioverter-defibrillator pulse generator. The code is selected based on the type of system; 33264 is reported for a multiple lead system. Do not report the removal of the pulse generator separately.


Procedure


Cardiovascular System/Pacemaker or Pacing Cardioverter-Defibrillator 33249 Insertion or repositioning replacement of elec-trode permanent pacing cardioverter-defibrillator system with transvenous lead(s) for, single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator

AAPC RationaleDescriptor language for code 33249 has been revised (delet-ing “repositioning, electrode” and adding “replacement, permanent”) for consistency with the terminology in this subsection; 33249 is reported for the insertion or replace-ment of the pacing cardioverter-defibrillator pulse generator and leads for a single or dual lead system.


Cardiovascular System/Cardiac Assist 33960 Prolonged extracorporeal circulation for cardiopul-monary insufficiency; initial 24 hours day

AAPC RationaleDescriptor language for 33960 was revised to clarify that the code should be reported for the date of service, not a 24-hour period.

Cardiovascular System/Cardiac Assist 33961 Prolonged extracorporeal circulation for cardio-pulmonary insufficiency; each additional 24 hours (List separately in addition to code for primary procedure) sub-sequent day

AAPC RationaleDescriptor language for 33961 was revised to clarify that the code should be reported for each subsequent date of service, and not each additional 24-hour period.

Cardiovascular System/Bypass Graft35548 Bypass graft, with vein; aortoiliofemoral, unilateral

AAPC RationaleCode 35548 was deleted; see codes 35537, 35539, 35565. Code determination is based on the vessels involved with the bypass graft.

Cardiovascular System/Bypass Graft35549 Bypass graft, with vein; aortoiliofemoral, bilateral

AAPC RationaleCode 35549 was deleted; see codes 35537, 35538, 35539, 35540, 35565. Code determination is based on the vessels involved with the bypass graft.

Cardiovascular System/Bypass Graft35551 Bypass graft, with vein; aortofemoral-popliteal

AAPC RationaleCode 35551 was deleted; see codes 35539, 35540, 35556, 35583. Code determination is based on the vessels involved with the bypass graft.

Cardiovascular System/Bypass Graft35651 Bypass graft, with other than vein; aortofemoral-popliteal

AAPC RationaleCode 35651 was deleted; see codes 35646, 35647, 35656. Code determination is based on the vessels involved with the bypass graft.

Cardiovascular System/Vascular Injection Procedures 36200 Introduction of catheter, aorta

AAPC RationaleIntroduction of catheter now includes moderate sedation, when performed.

Cardiovascular System/Vascular Injection Procedures 36245 Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family

AAPC RationaleCodes 36245–36248 for selective catheter placement, arte-rial system of the abdomen, pelvis, and lower extremity now include moderate sedation, when performed.

Procedure


Cardiovascular System/Vascular Injection Procedures 36246 Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family


Cardiovascular System/Vascular Injection Procedures 36247 Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family


Cardiovascular System/Vascular Injection Procedures 36248 Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (list in addition to code for initial second or third order vessel as appropriate


Cardiovascular System/Vascular Injection Proceduresl 36251 Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiologic supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral

AAPC RationaleFour new codes (36251–36254) were created to report renal catheterization and angioplasty. The AMA/Specialty Soci-ety RVS Update Committee (RUC) determined that these services were reported together at least 75 percent of the time. The new codes include “arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image post-processing, permanent recording of images and radiologic supervision and interpretation.”

Code 36251 is reported for first order selective renal cath-eterization and angioplasty performed unilaterally.

Cardiovascular System/Vascular Injection Proceduresl 36252 Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiog-raphy, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, per-manent recording of images, and radiologic supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral


Code 36252 is reported for first order selective renal cath-eterization and angioplasty performed bilaterally.

Cardiovascular System/Vascular Injection Proceduresl 36253 Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, includ-ing arterial puncture, catheterization, fluoroscopy, contrast injection(s), image post processing, permanent recording of images, and radiologic supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral

Procedure



Code 36253 is reported for one or more second or higher order superselective renal catheterization and angioplasty, performed unilaterally.

Cardiovascular System/Vascular Injection Proceduresl 36254 Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, includ-ing arterial puncture, catheterization, fluoroscopy, contrast injection(s), image post processing, permanent recording of images, and radiologic supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral


Code 36254 is reported for one or more second or higher order superselective renal catheterization and angioplasty, performed bilaterally.

Cardiovascular System/Transcatheter Proceduresl 37191 Insertion of intravascular vena cava filter, endo-vascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraproce-dural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed

AAPC RationaleWith the deletion of code 37620 and 75940, three new codes (37191–37193) were created to report procedures for intravas-cular vena cava filters. The new codes include the radiologi-cal supervision and interpretation and imaging guidance, when performed.

Code 37191 is reported for the insertion of an intravascular vena cava filter.

Cardiovascular System/Transcatheter Proceduresl 37192 Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selec-tion, and radiological supervision and interpretation, intra-procedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed


Code 37192 is reported for the repositioning of an intravas-cular vena cava filter.

Cardiovascular System/Transcatheter Proceduresl 37193 Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultra-sound and fluoroscopy), when performed


Code 37193 is reported for the removal of an intravascular vena cava filter.

Procedure


Cardiovascular System/Ligationl 37619 Ligation of inferior vena cava

AAPC RationaleWith the deletion of 37620 and 75940, 37619 was created to report the ligation of the inferior vena cava.

Cardiovascular System/Ligation37620 Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascu-lar (umbrella device)

AAPC RationaleCode 37620 was deleted; see new codes 37191, 37619.

Hemic and Lymphatic Systems/Bone Marrow or Stem Cell Services-Procedures 38208 Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, without washing, per donor

AAPC RationaleDescriptor language for codes 38208–38209 has been revised (adding “per donor”) to allow for multiple units to be reported when multiple blood cord units are required.

Hemic and Lymphatic Systems/Bone Marrow or Stem Cell Services-Procedures 38209 Transplant preparation of hematopoietic progeni-tor cells; thawing of previously frozen harvest, with washing, per donor

AAPC RationaleDescriptor language for codes 38208–38209 has been revised (adding “per donor”) to allow for multiple units to be reported when multiple blood cord units are required.

Hemic and Lymphatic Systems/Bone Marrow or Stem Cell Services-Procedures 38230 Bone marrow harvesting for transplantation; allogenic

AAPC RationaleAllogenic tissues are of the same species but genetically dis-similar/immunologically incompatible. Descriptor language was revised to distinguish 38230 from new code 38232 which describes autologous tissue.

Hemic and Lymphatic Systems/Bone Marrow or Stem Cell Services-Proceduresl 38232 Bone marrow harvesting for transplantation; autol-ogous

AAPC RationaleAutologous tissues are obtained from the same individual; 38230 has been revised and 38232 created to distinguish between an allogenic bone marrow harvest and autologous bone marrow harvest.

Hemic and Lymphatic Systems/Radical Lymphadenectomy + 38746 Thoracic lymphadenectomy, regional by tho-racotomy, including mediastinal peritracheal nodes and regional lymphadenectomy (List separately in addition to code for primary procedure)

AAPC RationaleDescriptor language for code 38746 has been revised to report the procedure approach and the location of the node resection.

Hemic and Lymphatic Systems/Introduction 38792 Injection procedure; radioactive tracer for identifi-cation of sentinel node

AAPC RationaleDescriptor language for code 38792 has been revised (adding “radioactive tracer”). This code is reported only when injec-tion of a radiotracer is performed.

Mediastinum and Diaphragm/Excision 39200 Excision Resection of mediastinal cyst

AAPC RationaleDescriptor language for 39200 has been revised (deleting “excision” and adding “resection”) for consistency.

Mediastinum and Diaphragm/Excision 39220 Excision Resection of mediastinal tumor

AAPC RationaleDescriptor language for 39220 has been revised (deleting “excision” and adding “resection”) for consistency.

Procedure


Mediastinum and Diaphragm/Endoscopy 39400 Mediastinoscopy, with or without biopsy includes biopsy(ies), when performed

AAPC RationaleDescriptor language for 39400 has been revised to indicate that the procedure includes biopsy(ies), when performed. This code is reported one time regardless of the number of biopsies performed.

Digestive System/Liver/Incision 47000 Biopsy of liver, needle; percutaneous

AAPC RationalePercutaneous needle biopsy of liver, as reported with 47000, now includes moderate sedation. This is the only change to the code.

Digestive System/abdomen, Peritoneum, and Omentum/Incision49080 Peritoneocentesis, abdominal paracentesis, or perito-neal lavage (diagnostic or therapeutic); initial

AAPC RationaleCode 49080 has been deleted; to report peroneocentesis/para-centesis see new codes 49082–49083.

Digestive System/abdomen, Peritoneum, and Omentum/Incision49081 Peritoneocentesis, abdominal paracentesis, or perito-neal lavage (diagnostic or therapeutic); subsequent

AAPC RationaleCode 49081 has been deleted; to report peroneocentesis/para-centesis see new codes 49082–49083.

Digestive System/abdomen, Peritoneum, and Omentum/Incisionl 49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

AAPC RationaleNew code 49082 describes abdominal paracentesis without imaging guidance. During this procedure, a needle is used to remove a sample of fluid or to drain fluid that has accu-mulated in the abdomen. To report abdominal paracentesis with imaging guidance, see 49083.

Digestive System/abdomen, Peritoneum, and Omentum/Incisionl 49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance

AAPC RationaleNew code 49083 describes abdominal paracentesis with imaging guidance. During this procedure, a needle is used to remove a sample of fluid or to drain fluid that has accu-mulated in the abdomen. Do not separately report imaging guidance (eg, 76942, 77002, 77012, or 77021) with 49083. To report abdominal paracentesis without imaging guidance, see 49082.

Digestive System/abdomen, Peritoneum, and Omentum/Incisionl 49084 Peritoneal lavage, including imaging guidance, when performed

AAPC RationaleNew code 49084 describes peritoneal lavage, a test used to determine the presence or absence of internal bleeding within the abdomen. The code includes imaging guidance, when performed; do not separately report imaging guidance (eg, 76942, 77002, 77012, or 77021) with 49084.

Surgery/Nervous SystemNervous System/Spine and Spinal Cord/Injection, Drainage, or Aspiration 62287 Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method single utilizing needle based technique to remove disc material under fluoroscopic imaging or multiple levels other form of indirect visualization, lumbar (eg with the use of an endo-scope, manual with discography and/or automated percutane-ous discectomy epidural injection(s) at the treated level(s), when performed, percutaneous laser discectomy) single or multiple levels, lumbar

AAPC RationaleWith the addition of new Cat. III codes 0274T and 0275T Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral

Procedure


or bilateral… to describe non-needle based percutaneous decompression of nucleus pulposus of intervertebral disc, 62287 has been revised to clearly identify it as a needle-based procedure with endoscopic approach, also distinct from an open approach. The procedure removes part of the nucleus pulposus (the gel center) from a ruptured disk, to decrease pressure on a spinal nerve root and relieve pain.

Code 62287 includes fluoroscopic imaging or other indirect visualization; do not report such imaging (eg, 77003, 77012, 72295) when performed at the same level. Do not report per-cutaneous aspiration with the nucleus pulposus (62267) dis-cography injection (62290), or diagnostic/therapeutic lumbar injection (62311) in addition to 62287.

Nervous System/Spine and Spinal Cord/Injection, Drainage, or Aspiration 62310 Injection(s), singe (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography) of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or sub-arachnoid; cervical or thoracic

AAPC RationaleDescriptor language for 62310 has been revised for clarity. The code is reported when a catheter is placed to admin-ister an epidural or subarachnoid injection(s) on a single day. Injections at one or more cervical or thoracic levels are counted as a single unit of 62310. Fluoroscopy, if used, may be separately reported with 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diag-nostic or therapeutic injection procedures (epidural or subarachnoid).

For lumbar or sacral injections, see 62311. For injections spanning several days, see 62318–62319.

Nervous System/Spine and Spinal Cord/Injection, Drainage, or Aspiration 62311 Injection(s), single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography)of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or sub-arachnoid; lumbar, or sacral (caudal)

AAPC RationaleDescriptor language for 62311 has been revised for clarity. The code is reported when a catheter is placed to adminis-ter an epidural or subarachnoid injection(s) on a single day. Injections at one or more lumbar or sacral levels are counted as a single unit of 62311. Fluoroscopy, if used, may be sepa-rately reported with 77003 Fluoroscopic guidance and localiza-tion of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid).

For cervical or thoracic injections, see 62310. For injections spanning several days, see 62318–62319.

Nervous System/Spine and Spinal Cord/Injection, Drainage, or Aspiration 62318 Injection(s), including indwelling catheter place-ment, continuous infusion or intermittent bolus, not includ-ing neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic

AAPC RationaleDescriptor language for 62318 has been revised for clarity. The code is reported when a catheter is placed to administer an epidural or subarachnoid injection(s) over an extended period (eg, two or more days), either continuously or via intermittent bolus. Injections at one or more cervical or thoracic levels are counted as a single unit of 62318. Fluoros-copy, if used, may be separately reported with 77003 Fluoro-scopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid).

For lumbar or sacral injections, see 62319. For injections on a single day, see 62310–62311.

Nervous System/Spine and Spinal Cord/Injection, Drainage, or Aspiration 62319 Injection(s), including indwelling catheter place-ment, continuous infusion or intermittent bolus, not includ-ing neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; lumbar, or sacral (caudal)

Procedure


AAPC RationaleDescriptor language for 62319 has been revised for clarity. The code is reported when a catheter is placed to administer an epidural or subarachnoid injection(s) over an extended period (eg, two or more days), either continuously or via intermittent bolus. Injections at one or more lumbar or sacral levels are counted as a single unit of 62319. Fluoroscopy, if used, may be separately reported with 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or para-spinous diagnostic or therapeutic injection procedures (epidural or subarachnoid).

For cervical or thoracic injections, see 62318. For injections on a single day, see 62310–62311.

Nervous System/Spine and Spinal Cord/Reservoir-Pump Implantation 62367 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming or refill

AAPC RationaleThe descriptor for 62367 has been revised to specify that the code applies for electronic analysis of implantable pump without pump reprogramming or refill. To report analysis with reprogramming but without refill, see 62368 (this code is unchanged from last year). To report analysis with repro-gramming and refill, see new code 62369.

Do not report 62367 with 95990 or 95991, which describe refilling and maintenance of a reservoir or an implantable infusion pump for spinal or brain drug delivery without reprogramming.

Nervous System/Spine and Spinal Cord/Reservoir-Pump Implantationl 62369 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill

AAPC RationaleNew code 62369 now applies for electronic analysis of implantable pump (eg, for intrathecal or epidural drug infu-sion) with pump reprogramming and refill. For analysis and reprogramming requiring physician skill, see 62370. For analysis without reprogramming and refill, see revised code

62367. For analysis with reprogramming but without refill, see 62368.


Nervous System/Spine and Spinal Cord/Reservoir-Pump Implantationl 62370 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring physician’s skill)

AAPC RationaleLike new code 62369, 62370 describes electronic analysis of implantable pump (eg, for intrathecal or epidural drug infu-sion) with pump reprogramming and refill; however, 62370 should be reported when the service specifically requires a physician’s skill. Documentation should support the need for physician skill, and that the physician provided the service.

For electronic analysis of an implanted pump without repro-gramming and refill, see revised code 62367. For analysis with reprogramming but without refill, see 62368.


Nervous System/Spine and Spinal Cord/Posterior Extradural Laminotomy or Laminectomy for Exploration-Decompression of Neural Elements or Excision of Herniated Intervertebral Discs 63020 Laminotomy (hemilaminectomy), with decompres-sion of nerve root(s), including partial facetectomy, forami-notomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, cervical

AAPC RationaleNew section guidelines specify that endoscopically assisted laminotomy requires open and direct visualization; there-

Procedure


fore, the descriptors for 63020–+63035 have been revised to eliminate the reference to “open and endoscopically-assisted” procedures (which is made redundant by the new guidelines). Laminotomy requiring only endoscopic and/or image guid-ance is by definition percutaneous, and should be reported using Cat. III codes 0274T and 0275T Percutaneous lami-notomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral….

Nervous System/Spine and Spinal Cord/Posterior Extradural Laminotomy or Laminectomy for Exploration-Decompression of Neural Elements or Excision of Herniated Intervertebral Discs 63030 Laminotomy (hemilaminectomy), with decompres-sion of nerve root(s), including partial facetectomy, forami-notomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, lumbar

AAPC RationaleNew section guidelines specify that endoscopically assisted laminotomy requires open and direct visualization; there-fore, the descriptors for 63020–+63035 have been revised to eliminate the reference to “open and endoscopically-assisted” procedures (which is made redundant by the new guidelines). Laminotomy requiring only endoscopic and/or image guid-ance is by definition percutaneous, and should be reported using Cat. III codes 0274T and 0275T Percutaneous lami-notomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral….

Nervous System/Spine and Spinal Cord/Posterior Extradural Laminotomy or Laminectomy for Exploration-Decompression of Neural Elements or Excision of Herniated Intervertebral Discs +63035 Laminotomy (hemilaminectomy), with decom-pression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral

disc, including open and endoscopically-assisted approaches; each additional interspace, cervical or lumbar (List separately in addition to code for primary procedure)

AAPC RationaleNew section guidelines specify that endoscopically assisted laminotomy requires open and direct visualization; there-fore, the descriptors for 63020–+63035 have been revised to eliminate the reference to “open and endoscopically-assisted” procedures (which is made redundant by the new guidelines). Laminotomy requiring only endoscopic and/or image guid-ance is by definition percutaneous, and should be reported using Cat. III codes 0274T and 0275T Percutaneous lami-notomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral….

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Neurostimulators (Peripheral Nerve) 64553 Percutaneous implantation of neurostimulator elec-trode array; cranial nerve

AAPC RationaleThe term “array” has been added for clarity, to ensure proper code application. Implanted neurostimulators typically con-tain multiple (usually four to eight) electrodes. CPT® specifi-cally defines an electrode array as “a catheter or other device with more than one contact.” The code should be applied once per array, not once per electrode. For example, if an implanted array includes four electrodes, proper coding is 64553, not 64553 x 4.

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Neurostimulators (Peripheral Nerve) 64555 Percutaneous implantation of neurostimulator elec-trode array; peripheral nerve (excludes sacral nerve)

AAPC RationaleThe term “array” has been added for clarity, to ensure proper code application. Implanted neurostimulators typically contain multiple (usually four to eight) electrodes. CPT® specifically defines an electrode array as “a catheter or other device with more than one contact.” The code should be

Procedure


applied once per array, not once per electrode. For example, if a single implanted array includes eight electrodes, proper coding is 64555, not 64555 x 8.

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Neurostimulators (Peripheral Nerve)64560 Percutaneous implantation of neurostimulator elec-trodes; autonomic nerve

AAPC RationaleCode 64560 has been deleted as obsolete.

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Neurostimulators (Peripheral Nerve) 64561 Percutaneous implantation of neurostimulator elec-trode array; sacral nerve (transforaminal placement)

AAPC RationaleThe term “array” has been added for clarity, to ensure proper code application. Implanted neurostimulators typically contain multiple (usually four to eight) electrodes. CPT® specifically defines an electrode array as “a catheter or other device with more than one contact.” The code should be applied once per array, not once per electrode. For example, if a single implanted array includes four electrodes, proper coding is 64561, not 64561 x 4.

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Neurostimulators (Peripheral Nerve) 64565 Percutaneous implantation of neurostimulator elec-trode array; neuromuscular

AAPC RationaleThe term “array” has been added for clarity, to ensure proper code application. Implanted neurostimulators typically contain multiple (usually four to eight) electrodes. CPT® specifically defines an electrode array as “a catheter or other device with more than one contact.” The code should be applied once per array, not once per electrode. For example, if a single implanted array includes eight electrodes, proper coding is 64565, not 64565 x 8.

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Neurostimulators (Peripheral Nerve) 64575 Incision for implantation of neurostimulator elec-trode array; peripheral nerve (excludes sacral nerve)


Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Neurostimulators (Peripheral Nerve)64577 Incision for implantation of neurostimulator elec-trodes; autonomic nerve


Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Neurostimulators (Peripheral Nerve) 64580 Incision for implantation of neurostimulator elec-trode array; neuromuscular


Procedure


Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Neurostimulators (Peripheral Nerve) 64581 Incision for implantation of neurostimulator elec-trode array; sacral nerve (transforaminal placement)

AAPC RationaleThe term “array” has been added for clarity, to ensure proper code application. Implanted neurostimulators typically contain multiple (usually four to eight) electrodes. CPT® specifically defines an electrode array as “a catheter or other device with more than one contact.” The code should be applied once per array, not once per electrode. For example, if a single implanted array includes eight electrodes, proper coding is 64581, not 64581 x 8.

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Neurostimulators (Peripheral Nerve) 64585 Revision or removal of peripheral neurostimulator electrode array


Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency)64622 Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level

AAPC RationaleCodes 64622–64627 have been deleted and replaced by new codes 64633–64636.

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency)64623 Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure)


Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency)64626 Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level


Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency)64627 Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level (List separately in addition to code for primary procedure)


Procedure


Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency)l # 64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint

AAPC RationaleWith the deletion of 64623–64627, CPT® has created four new codes (64633–64636) to describe paravertebral facet join injections. The new codes (unlike the previous codes) specifically include imaging guidance. Do not report 64633–64636 with imaging procedures 77003 Fluoroscopic guidance… or 77012 Computed tomography guidance….

Code 64633 describes injection of a single, initial cervi-cal or thoracic facet joint. Count only the number of facet joints injected, not individual injections. If the physician injects the same facet joint multiple times, claim just a single unit of service. For injection of additional cervical or thoracic facet joints, beyond the first, see add-on 64634; however, you may append modifier 50 Bilateral procedure for bilateral injections. For lumbar or sacral facet joint injections, see 64635–64636.

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency)l # +64634 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure)


Add-on 64634 describes injection of each additional cervi-cal or thoracic facet joint, beyond the first: You must apply 64634 only in addition to initial facet joint injection code 64633. Count only the number of facet joints injected, not individual injections. If the physician injects the same facet joint multiple times, claim just a single unit of ser-vice; however, you may append modifier 50 Bilateral proce-dure for bilateral injections. For lumbar or sacral facet joint injections, see 64635–64636.

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency)l # 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint


Code 64635 describes injection of a single, initial lumbar or sacral facet joint. Count only the number of facet joints injected, not individual injections. If the physician injects the same facet joint multiple times, claim just a single unit of service. For injection of additional cervical or thoracic facet joints, beyond the first, see add-on 64636; however, you may append modifier 50 Bilateral procedure for bilateral injections. For cervical or thoracic facet joint injections, see 64633–64634.

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System/Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency)l # +64636 Destruction by neurolytic agent, paraverte-bral facet joint nerve(s), with imaging guidance (fluoros-copy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)

Procedure



Add-on 64636 describes injection of each additional lumbar or sacral facet joint, beyond the first: You must apply 64636 only in addition to initial facet joint injec-tion code 64635. Count only the number of facet joints injected, not individual injections. If the physician injects the same facet joint multiple times, claim just a single unit of service; however, you may append modifier 50 Bilateral procedure for bilateral injections. For cervical or thoracic facet joint injections, see 64633–64634.

fluoroscopy). For fluoroscopic guidance with diagnostic lead evaluation without insertion, replacement, or revision, see 76000 Fluoroscopy (separate procedure)….

Diagnostic Radiology/Spine and Pelvis 72114 Radiologic examination, spine, lumbosacral; com-plete, including bending views, minimum of 6 views

AAPC RationaleBending films may help to differentiate structural from non-structural curves of the spine, for instance in the diagnosis of scoliosis. The descriptor for 72114 has been revised to describe a “complete” examination as including a minimum of six views, with bending views. For bending views only (2–3 views), see 72120.

Diagnostic Radiology/Spine and Pelvis 72120 Radiologic examination, spine, lumbosacral; bend-ing views only, 2 or 3 views

AAPC RationaleBending films may help to differentiate structural from nonstructural curves of the spine, for instance in the diag-nosis of scoliosis. The descriptor for 72120 has been revised to describe two or three bending views only. For a complete exam, including bending views, see 72114.

Diagnostic Radiology/Lower Extremities73542 Radiological examination, sacroiliac joint arthrogra-phy, radiological supervision and interpretation

AAPC RationaleArthrography is now an inclusive component of revised code 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed.

Diagnostic Radiology/Abdomenl 74174 Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing

AAPC RationaleCode 74174 has been added to describe a combined com-puted tomographic angiography (CTA) of the abdomen and CTA of the pelvis; these services are frequently performed together to visualize arterial and venous vessels. Do not

AAPC RationaleAuditory System/Inner Ear/Incision and-or Destruction

69802 Labyrinthotomy, with perfusion of vestibuloactive drug(s); with mastoidectomy


RadiologyDiagnostic Radiology/Head and Neck 70355 Orthopantogram (eg, panoramic X-ray)

AAPC RationaleAn orthopantogram (also: orthopantomogram (OPG) or panorex) is a panoramic dental X-ray of the upper and lower jaw, showing a two-dimensional view from ear to ear. The descriptor for 70355 now specifies “(eg., panoramic X-ray)” to better define the code and its use, which does not change from previous years.

Diagnostic Radiology/Chest71090 Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation

AAPC RationaleCode 71090 has been deleted: For pacemaker or pacing cardioverter-defibrillator lead insertion, replacement, or revi-sion with guidance, see 33206–33249 (which now include

Procedure


report individual studies (eg, 72191, 73706, 74175, 75635, 76376, 76377) in addition to 74174.

For CTA aorto-iliofemoral runoff, use 75635.

Radiology/Vascular Procedures/Aorta and Arteries75722 Angiography, renal, unilateral, selective (including flush aortogram), radiological supervision and interpretation

AAPC RationaleCode 75722 has been deleted; unilateral angiography is now bundled to new selective catheter placement codes 36251 Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measure-ments when performed, and flush aortogram when performed; unilat-eral and 36253 Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocess-ing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when per-formed, and flush aortogram when performed; unilateral.

Radiology/Vascular Procedures/Aorta and Arteries75724 Angiography, renal, bilateral, selective (including flush aortogram), radiological supervision and interpretation

AAPC RationaleCode 75724 has been deleted; bilateral angiography is now bundled to new selective catheter placement codes 36252 Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral and 36254 Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure

gradient measurements when performed, and flush aortogram when performed; bilateral.

Radiology/Vascular Procedures/Transcatheter Procedures75940 Percutaneous placement of IVC filter, radiological supervision and interpretation

AAPC RationaleCode 75940 has been deleted: Radiological supervision and interpretation is now an inclusive component of 37191 Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervi-sion and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed.

Radiology/Vascular Procedures/Transcatheter Procedures 75962 Transluminal balloon angioplasty, peripheral artery other than cervical corotid, renal, or other visceral artery, iliac or lower extremity, radiological supervision and interpretation

AAPC RationaleDescriptor language for 75962 has been revised to eliminate reference to the cervical corotid artery. This code describes radiological supervision and interpretation only; for translu-minal angioplasty, see 35458 (open) and 35475 (percutane-ous).

Radiology/Vascular Procedures/Transcatheter Procedures +75964 Transluminal balloon angioplasty, each additional peripheral artery other than cervical carotid, renal, or other visceral artery, iliac and or lower extremity, radiological supervision and interpretation (List separately in addition to code for primary procedure)

AAPC RationaleDescriptor language for 75964 has been revised to eliminate reference to the cervical corotid artery. As an add-on code, 75964 should be used in addition to primary supervision and interpretation (S&I) code 75962 for each additional iliac or lower extremity peripheral artery imaged, other then renal or other visceral artery. For transluminal angioplasty, see 35458 (open) and 35475 (percutaneous).

Procedure


Radiologic Guidance/Fluoroscopic Guidance 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, subarachnoid, or sacroiliac joint subarachnoid), including neurolytic agent destruction

AAPC RationaleImaging guidance is now an included component of destruction of facet joint nerves by neurolytic agent (ie, 27096, 64633–64636); the code descriptor for 77003 has been revised to reflect this change. Do not report 77003 in addition to 27096, injection of anesthetic agent/steroid 64479–64484, injection of diagnostic or therapeutic agent 64490–64495, or 64633–64636.

Other Radiologic Guidance/Bone-Joint Studies77079 Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)


Other Radiologic Guidance/Bone-Joint Studies77083 Radiographic absorptiometry (eg, photodensitometry, radiogrammetry), 1 or more sites


Radiation Treatment Managementl # 77424 Intraoperative radiation treatment delivery, X-ray, single treatment session

AAPC RationaleCode 77424 (and 77425 and 77469) has been added to allow separate identification and reporting of intraopera-tive radiation treatment (IORT) delivery and management; 77424 specifically describes a single IORT treatment ses-sion using X-rays (for delivery using electrons, see 77425). IORT delivers high-dose radiation precisely to a targeted area while shielding surrounding tissue.

IORT services include simulations but do not include E/M services beyond the treatment management session (77469).

Previously, this service would have been reported using 77470 (revised for 2012).

Radiation Treatment Managementl # 77425 Intraoperative radiation treatment delivery, electrons, single treatment session

AAPC RationaleCode 77425 (and codes 77424 and 77469) has been added to allow separate identification and reporting of intraoperative radiation treatment (IORT) delivery and management; 77425 specifically describes a single IORT treatment session using electrons (for delivery using X-rays, see 77424). IORT delivers high-dose radiation precisely to a targeted area while shielding surrounding tissue.

IORT services include simulations but do not include E/M services beyond the treatment management session (77469).

Previously, this service would have been reported using 77470 (revised for 2012).

Radiation Treatment Managementl # 77469 Intraoperative radiation treatment manage-ment

AAPC RationaleCode 77469 (and codes 77424 and 77425) has been added to allow separate identification and reporting of intraop-erative radiation treatment (IORT) delivery and manage-ment. IORT delivers high-dose radiation precisely to a targeted area while shielding surrounding tissue.

Code 77469 specifically describes treatment management for IORT using either X-rays or electrons. E/M services beyond the treatment management are not included in 77469.

Procedure


Radiation Treatment Management 77470 Special treatment procedure (eg, total body irradia-tion, hemibody radiation, per oral, or intraopearative cone irradiation endocavitary irradiation)

AAPC RationaleWith the addition of 77424, 77425 and 77469 for separate identification and reporting of intraoperative radiation treat-ment (IORT), the descriptor for 77470 has been revised to eliminate the reference to intraoperative cone irradiation. You should no longer use 77470 to describe IORT.

Nuclear Medicine/ Diagnostic/Gastrointestinal System78220 Liver function study with hepatobiliary agents, with serial images


Nuclear Medicine/ Diagnostic/Gastrointestinal System78223 Hepatobiliary ductal system imaging, including gall-bladder, with or without pharmacologic intervention, with or without quantitative measurement of gallbladder function

AAPC RationaleCode 78223 for hepatobiliary system imaging has been deleted and replaced by two new, more specific codes 78226 and 78227, below.

Nuclear Medicine/ Diagnostic/Gastrointestinal Systeml 78226 Hepatobiliary system imaging, including gallblad-der when present;

AAPC RationaleCode 78226 describes hepatobiliary system imaging only; for imaging with pharmacological stimulation of gallbladder and contraction, including quantification of gallbladder or hepatic function, see 78227.

Hepatobiliary system imaging evaluates the function of the liver, gall bladder, and the ducts that connect them.

Nuclear Medicine/ Diagnostic/Gastrointestinal Systeml 78227 Hepatobiliary system imaging, including gallblad-der when present; with pharmacologic intervention, includ-ing quantitative measurement(s) when performed

AAPC RationaleCode 78227 describes hepatobiliary system imaging with pharmacological stimulation of gallbladder and contraction, including quantification of gallbladder or hepatic function. For imaging only, see 78226.

Hepatobiliary system imaging evaluates the function of the liver, gall bladder, and the ducts that connect them

Nuclear Medicine/ Diagnostic/Respiratory Systeml 78579 Pulmonary ventilation imaging (eg, aerosol or gas)

AAPC RationaleCode 78579 has been added to report pulmonary ventilation imaging, which is used to see how well air moves through the lungs. The code may be applied whether the image is performed for aerosols or gases. Report 78579 only one time per imaging session.

For particulate perfusion imaging, see revised code 78580. For combined pulmonary ventilation and perfusion (aerosol or gas), see new code 78582.

Nuclear Medicine/ Diagnostic/Respiratory System 78580 Pulmonary perfusion imaging (eg, particulate)

AAPC RationaleCode 78580 has been revised to report pulmonary perfusion imaging with radioactive-labeled particles, which is used to measure the blood supply through the lungs. Report 78580 only one time per imaging session.

To report pulmonary ventilation imaging using an aerosol or gas, see new code 78579. For combined pulmonary ventilation (aerosol or gas) and perfusion, see new code 78582.

Procedure


Nuclear Medicine/ Diagnostic/Respiratory Systeml 78582 Pulmonary ventilation (eg, aerosol or gas) and per-fusion imaging

AAPC RationaleNew code 78582 has been added to report combined pul-monary ventilation (aerosol or gas) and perfusion, which together measure how well air and blood move through the lungs. Report 78582 only one time per imaging session.

For ventilation imaging only, see 78579. For perfusion imag-ing only, see 78580.

Nuclear Medicine/ Diagnostic/Respiratory System78584 Pulmonary perfusion imaging, particulate, with ven-tilation; single breath

AAPC RationaleCode 78584 has been deleted; see instead new codes 78579, 78582–78598.

Nuclear Medicine/ Diagnostic/Respiratory System78585 Pulmonary perfusion imaging, particulate, with ventilation; rebreathing and washout, with or without single breath


Nuclear Medicine/ Diagnostic/Respiratory System78586 Pulmonary ventilation imaging, aerosol; single projection


Nuclear Medicine/ Diagnostic/Respiratory System78587 Pulmonary ventilation imaging, aerosol; multiple pro-jections (eg, anterior, posterior, lateral views)


Nuclear Medicine/ Diagnostic/Respiratory System78588 Pulmonary perfusion imaging, particulate, with ven-tilation imaging, aerosol, 1 or multiple projections


Nuclear Medicine/ Diagnostic/Respiratory System78591 Pulmonary ventilation imaging, gaseous, single breath, single projection


Nuclear Medicine/ Diagnostic/Respiratory System78593 Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or without single breath; single projection


Nuclear Medicine/ Diagnostic/Respiratory System78594 Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or without single breath; mul-tiple projections (eg, anterior, posterior, lateral views)


Procedure


Nuclear Medicine/ Diagnostic/Respiratory System78596 Pulmonary quantitative differential function (ventila-tion/perfusion) study


Nuclear Medicine/ Diagnostic/Respiratory Systeml 78597 Quantitative differential pulmonary perfusion, including imaging when performed

AAPC RationaleThis procedure is intended to measure functional blood flow of the lungs. More specifically, it is a non-invasive (non-surgical) method of measuring the volume of lung receiving blood flow from the pulmonary arteries, and of providing a picture of how air is distributed.

The patient’s arm is injected with a radioactive tracer. If all is well, the scan will show an even distribution of radioactive material throughout both lungs. Areas of the lungs in which the radioactive material does not appear can indicate any number of conditions. Normally, it indicates a pulmonary embolism—a blocked artery or blood clot in the lung. It can also indicate the presence of a tumor or another lung disease, such as emphysema or pneumonia.

Report 78587 only one time per imaging session.

Nuclear Medicine/ Diagnostic/Respiratory Systeml 78598 Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed

AAPC RationaleThis procedure is intended to measure functional blood flow of the lungs. More specifically, it is a non-invasive (non-surgical) method of measuring the volume of lung receiving blood flow from the pulmonary arteries, and of providing a picture of how air is distributed.

The patient’s arm is injected with a radioactive tracer. If all is well, the scan will show an even distribution of radioactive material throughout both lungs. Areas of the lungs in which

the radioactive material does not appear can indicate any number of conditions. Normally, it indicates a pulmonary embolism—a blocked artery or blood clot in the lung. It can also indicate the presence of a tumor or another lung disease, such as emphysema or pneumonia.

The perfusion scan is usually performed at the same time as a ventilation scan. A mask is placed over the patient’s face and he or she breathes a mixture of air and a mildly radioac-tive gas. The resulting images show which areas of the lungs may be receiving insufficient air during normal respiration.

Report 78598 only one time per imaging session.

Pathology and LaboratoryMolecular PathologyAAPC RationaleCPT® 2012 adds an entirely new subsection and 101 new codes (81200–81408) to the Pathology and Laboratory chap-ter to describe molecular pathology procedures. Molecular pathology is the study and diagnosis of disease through the examination of nucleic acid (including DNA and RNA). It is used to:

• Help to make rapid and accurate diagnoses.

• Detect and monitor infectious agents.

• Establish clonality (cells descended from and genetically identical to a single common ancestor), particularly for lymphoid diseases.

• Assess the presence of minimal residual disease for some malignancies following therapy.

• Determine prognosis and/or predict response to therapy.

• Perform testing for inherited diseases.

CPT® includes two full pages of instruction and definitions for proper application of molecular pathology codes, which are divided into Tier 1 (92 codes) and less-commonly-performed Tier 2 (9 codes) procedures. Individual codes are assigned according to the particular gene analyzed (eg, 81200 ASPA (aspartoacylase) (eg, Canavan disease) gene analysis, common variants (eg, E285A, Y231X)). Molecular pathology codes include all analytical services (qualitative, unless otherwise noted) performed in the test: bundled services include cell lysis and nucleic acid stabilization. Procedures required prior to cell lysis (such as 88380 and 88381, microdissection) may be separately reported.

Coders needing to apply the molecular pathology services codes should consult their 2012 CPT® manual for complete

Procedure


instructions and parenthetical guidelines, definitions, codes, and descriptors.

Immunologyl 86386 Nuclear Matrix Protein 22 (NMP22), qualitative

AAPC RationaleCode 86386 has been added to report qualitative nuclear matrix protein 22 (NMP22) testing, for specific identifica-tion of the NMP22 protein. This test is valuable in the diag-nosis of bladder cancer.

Previously, this service would have been reported using 86294 Immunoassay for tumor antigen, qualitative or semiquantitative (eg, bladder tumor antigen)

Immunology 86703 Antibody; HIV-1 and HIV-2, single assay result

AAPC RationaleTo accommodate new code 87389 for HIV-1 antigen(s) with HIV-1 and HIV-2 antibodies (below), the descriptor for 86703 has been revised to specify “single result.” This test identifies only HIV antibodies.

When this test is performed using a kit or transportable instrument consisting of a single use, disposable analytical chamber, you should append modifier 92 Alternative laboratory platform testing to 86703.

Microbiologyl 87389 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result

AAPC RationaleNew code 87389 has been added to describe HIV-1 antigen(s) with HIV-1 and HIV-2 antibodies, single result. This differs from those tests that identify antibodies only (eg, 86703).

When this test is performed using a kit or transportable instrument consisting of a single use, disposable analytical chamber, you should append modifier 92 Alternative laboratory platform testing to 87389.

Cytopathology88107 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears and simple filter preparation with interpretation

AAPC RationaleCode 88107 has been deleted as obsolete. To report smears and simple filter preparation, see 88104 Cytopathology, fluids, washings or brushings; except cervical or vaginal; smears with interpretation and 88106 …simple filter method with interpretation.

Cytopathology 88312 Special stain including interpretation and report; Group I for microorganisms (eg, Gridley acid fast, methenamine silver), including interpretation and report, each

AAPC RationaleDescriptors in the range 88312–88319 have been revised to better define special stains where procedures overlap two code definitions.

Cytopathology 88313 Special stain including interpretation and report; Group II, all other (eg, iron, trichrome), except immunocytochemistry and immunoperoxidase stain for microorganisms, stains for enzyme constituents, including interpretation or immunocytochemistry and report, each immunohistochemistry


Cytopathology +88314 Special stain including interpretation and report; histochemical staining with on frozen section(s) including interpretation and report tissue block (List separately in addition to code for primary procedure)


Procedure


Cytopathology88318 Determinative histochemistry to identify chemical components (eg, copper, zinc)

AAPC RationaleWith the revision of 88312–88314 and 99319, code 88318 has been deleted as unnecessary. For determinative histo-chemistry to identify chemical components, see 88313.

Cytopathology 88319 Special stain including interpretation and report; Group III, for enzyme constituents


MedicineImmunization Administration for Vaccines-Toxoids 90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine/or toxoid component admin-istered

AAPC RationaleDescriptor language has been revised to clarify code use for the first or only component of each vaccine or toxoid admin-istered. A component is any vaccine antigen that prevents disease(s) caused by a single type of organism. You should report a single unit of 90460 for each vaccine administered; if a vaccine contains more than one component, you should report administration of additional components using add-on code 90461 …each additional vaccine or toxoid component administered.

Report 90460/90461 only if the physician or other qualified health care professional provides face-to-face counseling of the patient and/or family during the vaccine administration. If no face-to-face counseling occurs, or if the patient is over 18 years of age, report 90471–90474.

Immunization Administration for Vaccines-Toxoids +90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/or toxoid component administered (List separately in addition to code for primary procedure)

AAPC RationaleDescriptor language has been revised to mirror that of the primary code, 90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine/or toxoid administered.

A component is any vaccine antigen that prevents disease(s) caused by a single type of organism. You should report a single unit of 90460 for each vaccine administered; if a vac-cine contains more than one component, you should report administration of additional components using add-on code 90461 …each additional vaccine or toxoid component adminis-tered.

For example, an HPV vaccine includes a single component and would be coded as 90460, whereas a DTaP contains three components and would be reported 90460, 90461 x 2. Vaccine administration codes are reported in addition to vac-cine and toxoid codes(s) 90476–90746.

Immunization Administration for Vaccines-Toxoids90470 H1N1 Immunization administration (intramuscular, intranasal), including counseling when performed

AAPC RationaleCode 90470 has been deleted; the H1NI vaccine is no longer offered. The 2010–2011 flu season vaccine incorporates the H1N1 virus.

Vaccines, Toxoids 90581 Anthrax vaccine, for subcutaneous or intramuscular use

AAPC RationaleThe term “or intramuscular” has been added to the descriptor to allow use of this code to describe either subcutaneous or intramuscular anthrax vaccine.

Procedure


Vaccines, Toxoids 90644 Meningococcal conjugate vaccine, serogroups C & Y and hemophilus influenza B vaccine tetanus toxoid conjugate (Hib-MenCY-TT) (Hib-MenCY), 4 dose sched-ule, when administered to children 2–15 months of age, for intramuscular use

AAPC RationaleDescriptor language has been updated to specify H. influ-enza type B (Hib) and N. meningitis serogroups C (MenC) and Y (MenY)-tetanus toxoid conjugate vaccine (Hib-MenCY). Note that this is a two-component (not three-com-ponent) vaccine. Code application does not change.

Vaccines, Toxoidsl 90654 Influenza virus vaccine, split virus, preservative-free, for intradermal use

AAPC RationaleCode 90654 has been added to describe a lower antigen con-centration than influenza vaccines intended for intramuscular delivery (90656, 90658); this influenza vaccine is preserva-tive free and is administered using a prefilled, single-dose, disposable intra-dermal microinjection system. Code 90654 was accepted at the June 2010 CPT® Editorial Panel meeting for the 2012 CPT® book production cycle. The code was not included in the 2011 CPT® codebook; however, due to the Category I vaccine product codes early release policy, 90654 code was effective Jan. 1, 2011.

Vaccines, Toxoids90663 Influenza virus vaccine, pandemic formulation, H1N1

AAPC RationaleCode 90663 has been deleted; the H1NI vaccine is no longer offered. The 2010–2011 flu season vaccine incorporates the H1N1 virus

Psychiatric Therapeutic Procedures/ Other Psychiatric Services or Procedures 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; planning initial, including cortical mapping, motor threshold determination, delivery and management

AAPC RationaleThe descriptor language has been revised to describe the content of the service as an initial TMS treatment, to include

specifically cortical mapping, motor threshold determination, and the initial delivery and management. Subsequent delivery and management may be reported per session, using revised code 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session.

TMS uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression, and it has been tested as a treatment tool for other neurological and psychi-atric disorders including migraines, Parkinson’s disease, audi-tory hallucinations, and more.

Psychiatric Therapeutic Procedures/ Other Psychiatric Services or Procedures 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and man-agement, per session

AAPC RationaleThe descriptor language has been revised to describe subse-quent TMS delivery and management, per session. For initial TMS treatment (cortical mapping, motor threshold determi-nation, and initial delivery and management), turn to 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management.

TMS uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression, and it has been tested as a treatment tool for other neurological and psychi-atric disorders including migraines, Parkinson’s disease, audi-tory hallucinations, and more.

Psychiatric Therapeutic Procedures/ Other Psychiatric Services or Proceduresl 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management

AAPC RationaleCode 90869 has been added to describe subsequent motor threshold re-determination with delivery and management for TMS, a procedure that uses magnetic fields to stimulate nerve cells in the brain and improve symptoms of depres-sion. For initial motor threshold determination with delivery and management, see 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management.

Procedure


For subsequent delivery and management without motor threshold determination, see 90868 Therapeutic repetitive tran-scranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session.

Gastroenterology 91010 Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; 2-dimensional data

AAPC RationaleThe code descriptor has been revised to eliminate the refer-ence to 2-dimensional data. These studies occur for evalu-ation of esophageal motility disorders such as achalasia or esophageal spasm. This procedure occurs without pressure topography.

To code stimulation or perfusion with motility study, report +91013 Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for primary proce-dure) in addition to 91010.

For high resolution esophageal motility studies, use 0240T Esophageal motility (manometric study of the esophagus and/or gas-troesophageal junction) study with interpretation and report; with high resolution esophageal pressure topography.

Gastroenterology +91013 Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion during 2-dimensional data study (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for pri-mary procedure)

AAPC RationaleThe code descriptor has been revised to eliminate the refer-ence to 2-dimensional data. These studies occur for evalu-ation of esophageal motility disorders such as achalasia or esophageal spasm. This procedure occurs without pressure topography

To code stimulation or perfusion with motility study, report +91013 Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion (eg, stimulant, acid or alkali

perfusion) (List separately in addition to code for primary proce-dure) in addition to 91010.

For high resolution esophageal motility studies, use 0240T Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with high resolution esophageal pressure topography with 0241T Esophageal motility (manometric study of the esophagus and/or gas-troesophageal junction) study with interpretation and report; with stimulation or perfusion during high resolution esophageal pressure topography study (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for primary procedure).

Ophthalmology/Special Ophthalmological Services92070 Fitting of contact lens for treatment of disease, includ-ing supply of lens

AAPC RationaleCode 92070 has been replaced by new codes 92071–92072, which more precisely describe the disease for which contact lenses are fitted.

Ophthalmology/Special Ophthalmological Servicesl 92071 Fitting of contact lens for treatment of ocular sur-face disease

AAPC RationaleCode 92071, along with 92072 Fitting of contact lens for man-agement of keratoconus, initial fitting, replaces deleted code 92070 for fitting of contact lens for treatment of disease; 92071 is specific to ocular surface disease. Supply of lens may be reported separately using 99070 Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided), or an appropriate HCPCS Level II supply code.

Do not report 92071 and 92072 together.

Ophthalmology/Special Ophthalmological Servicesl 92072 Fitting of contact lens for management of keratoco-nus, initial fitting

AAPC Rationale

Procedure


Special Otorhinolaryngologic Services/Audiologic Function Testsl # 92558 Evoked otoacoustic emissions, screening (quali-tative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis

AAPC RationaleNew code 92558 describes evoked otoacoustic emissions screening (for hearing impairment) by automated analysis. A device evaluates the patient using automated algo-rithms, which determines whether emissions are present.

Code 92072, along with 92071 Fitting of contact lens for treat-ment of ocular surface disease, replaces deleted code 92070 for fitting of contact lens for treatment of disease; 92072 is specific to an initial fitting for management of keratoconus. Subsequent fittings may be reported using E/M service codes or general ophthalmological services codes.

Supply of lens may be reported separately using 99070 Sup-plies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided), or an appropriate HCPCS Level II supply code.

Do not report 92072 and 92071 together.

Ophthalmology/Special Ophthalmological Services92120 Tonography with interpretation and report, recording indentation tonometer method or perilimbal suction method

AAPC RationaleCode 92120 has been deleted due to low use.

Ophthalmology/Special Ophthalmological Services92130 Tonography with water provocation

AAPC RationaleCode 92130 has been deleted due to low use.

Special Otorhinolaryngologic Services/Audiologic Function Tests 92587 Evoked Distortion product evoked otoacoustic emissions; limited evaluation (single stimulus level to con-firm the presence or absence of hearing disorder, either 3–6 frequencies) or transient of distortion produces) evoked oto-acoustic emissions, with interpretation and report

AAPC RationaleDescriptor language for 92587 has been revised to clarify the intent of the code, which should be applied for the use of a limited number of frequencies to determine if the patient has experienced hearing loss.

Special Otorhinolaryngologic Services/Audiologic Function Tests 92588 Evoked Distortion product evoked otoacoustic emissions; comprehensive or diagnostic evaluation (compari-son quantitative analysis of transient and/or distortion prod-uct otoacoustic emissions at multiple levels and outer hair cell function by cochlear mapping, minimum of 12 frequen-cies), with interpretation and report

AAPC RationaleDescriptor language for 92588 has been revised to clarify the intent of the code, which should be applied for comprehen-sive—minimum of 12 frequencies—otoacoustic emissions testing (as opposed to limited testing, 92587).

Special Otorhinolaryngologic Services/ Evaluative and Therapeutic Services 92605 Evaluation for prescription of non-speech-gener-ating augmentative and alternative communication device, face-to-face with the patient; first hour

AAPC RationaleThis service has been redefined to specify face-to-face interac-tion with the patient, and is now time based; report 92065 for the first hour and new code 92618 Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (List separately in addition to code for primary procedure) for each addi-tional 30 minutes of face-to-face evaluation with the patient.

Augmentative and alternative communication devices are aids that allow individuals with severe speech impairment or absent speech to meet their functional communication needs.

Procedure


Special Otorhinolaryngologic Services/ Evaluative and Therapeutic Servicesl # +92618 Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (List separately in addition to code for primary procedure)

AAPC RationaleAugmentative and alternative communication devices are aids to allow individuals with severe speech impairment or absent speech to meet their functional communication needs. Report revised code 92605 Evaluation for prescription of non-speech-generating augmentative and alternative commu-nication device, face-to-face with the patient; first hour for the first hour and add-on 92618 for each additional 30 min-utes of face-to-face evaluation with the patient.

Special Otorhinolaryngologic Services/ Evaluative and Therapeutic Services +92621 Evaluation of central auditory function, with report; each additional 15 minutes (List separately in addi-tion to code for primary procedure)

AAPC RationaleAdd-on 92621 should be used in addition to 92620 Evalua-tion of central auditory function, with report; initial 60 minutes to report time-based evaluations of central auditory function, for instance to diagnose central auditory processing disorders (CAPD). Code 92620 reports the first hour of service; 92621 reports each additional 15 minutes. A revised descriptor reminds the coder that 92621 must be reported in addition to the primary procedure (92620).

Cardiovascular/Injection Procedures 93561 Indicator dilution studies such as dye or ther-mal dilution thermodilution, including arterial and/or venous catheterization; with cardiac output measurement (separate procedure)

AAPC RationaleA minor spelling revision does not change application of the code.

Indicator dilution studies are performed to measure car-diac output. The thermodilution technique uses a special thermistor-tipped catheter (Swan-Ganz catheter) to measure

temperature differences following injection of a cold saline solution into the blood. Using this data, a computer can calculate blood flow. The injection may be repeated several times and the cardiac output averaged. The indicator dilu-tion technique is based on the principle that the volume of blood flow is related to the average dye concentration and the time taken for passage of the dye.

For subsequent cardiac output measurement, see 93562 Indicator dilution studies such as dye or thermodilution, including arterial and/or venous catheterization; subsequent measurement of cardiac output.

Code 93561 includes cardiac catheterization, 93451–93462.

Cardiovascular/Injection Procedures 93562 Indicator dilution studies such as dye or thermal dilution thermodilution, including arterial and/or venous catheterization; subsequent measurement of cardiac output

AAPC RationaleA minor spelling revision does not change application of the code.

A thermodilution indicator dilution study uses a thermistor-tipped catheter (Swan-Ganz catheter) to measure temperature differences following injection of a cold saline solution into the blood. Using this data, a computer can calculate blood flow. The injection may be repeated several times and the cardiac output averaged. The indicator dilution technique is based on the principle that the volume of blood flow is related to the average dye concentration and the time taken for passage of the dye.

Code 93562 reports that subsequent measurement of car-diac output was performed. Code 93562 cannot be reported without 93561 because a subsequent measurement of cardiac output cannot occur unless the initial cardiac output mea-surement was performed.

Do not report cardiac catheterization (93451–93462) in addition to 93562.

Cardiovascular/Noninvasive Vascular Diagnostic Studies/Noninvasive Physiologic Studies and Procedures93720 Plethysmography, total body; with interpretation and report

Procedure


AAPC RationaleCode 93720 has been deleted and replaced by new code 94726 Plethysmography for determination of lung volumes and, when performed, airway resistance.

Cardiovascular/Noninvasive Vascular Diagnostic Studies/Noninvasive Physiologic Studies and Procedures93721 Plethysmography, total body; tracing only, without interpretation and report


Cardiovascular/Noninvasive Vascular Diagnostic Studies/Noninvasive Physiologic Studies and Procedures93722 Plethysmography, total body; interpretation and report only


Cardiovascular/Cerebrovascular Arterial Studies93875 Noninvasive physiologic studies of extracranial arter-ies, complete bilateral study (eg, periorbital flow direction with arterial compression, ocular pneumoplethysmography, Doppler ultrasound spectral analysis)

AAPC RationaleCode 93875 has been deleted; the service it describes is obsolete.

Cardiovascular/Other Noninvasive Vascular Diagnostic Studiesl 93998 Unlisted noninvasive vascular diagnostic study

AAPC RationaleCode 93998 has been added as an “unlisted procedure” code to describe any noninvasive vascular diagnostic study not described by another, specific CPT® code.

Pulmonary/Other Procedures94240 Functional residual capacity or residual volume: helium method, nitrogen open circuit method, or other method thoracic gas volume

AAPC RationaleCode 92420 has been deleted; to report thoracic gas volumes, see new codes 94726 Plethysmography for determination of lung volumes and, when performed, airway resistance and 94727 Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes.

Pulmonary/Other Procedures94350 Determination of maldistribution of inspired gas: multiple breath nitrogen washout curve including alveolar nitrogen or helium equilibration time

AAPC RationaleCode 94350 has been deleted; see new codes 94726 Plethysmography for determination of lung volumes and, when performed, airway resistance and 94727 Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes.

Pulmonary/Other Procedures94360 Determination of resistance to airflow, oscillatory or plethysmographic methods

AAPC RationaleCode 94360 has been deleted; see new codes 94726 Plethysmography for determination of lung volumes and, when performed, airway resistance and 94728 Airway resistance by impulse oscillometry.

Pulmonary/Other Procedures94370 Determination of airway closing volume, single breath tests

AAPC RationaleCode 94370 has been deleted; see new codes 94726 Plethys-mography for determination of lung volumes and, when performed, airway resistance and 94727 Gas dilution or washout for determi-nation of lung volumes and, when performed, distribution of venti-lation and closing volumes.

Procedure


Pulmonary/Other Procedures94720 Carbon monoxide diffusing capacity (eg, single breath, steady state)

AAPC RationaleCode 94720 has been deleted; see new add-on code +94729 Diffusing capacity (eg, carbon monoxide, membrane) (List sepa-rately in addition to code for primary procedure).

Pulmonary/Other Procedures94725 Membrane diffusion capacity

AAPC RationaleCode 94725 has been deleted; see new add-on code +94729 Diffusing capacity (eg, carbon monoxide, membrane) (List sepa-rately in addition to code for primary procedure).

Pulmonary/Other Proceduresl 94726 Plethysmography for determination of lung volumes and, when performed, airway resistance

AAPC RationaleNew code 94726 (along with new codes 94727 Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes and 94728 Airway resistance by impulse oscillometry) replaces deleted codes 94260, 94350, 94360, and 94370. Code 94726 specifically describes use of pulmonary plethysmograph to measure the functional residual capacity (FRC) of the lungs—the volume in the lungs when the muscles of respiration are relaxed—and total lung capacity.

Pulmonary/Other Proceduresl 94727 Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes

AAPC RationaleNew code 94727 (along with new codes 94726 Plethysmog-raphy for determination of lung volumes and, when performed, airway resistance and 94728 Airway resistance by impulse oscil-lometry) replaces deleted codes 94260, 94350, 94360, and 94370. Code 94727 specifically describes measurement of lung volumes by helium dilution or nitrogen washout, including determination of total lung capacity and all con-tributory lung volume determinations.

Pulmonary/Other Proceduresl 94728 Airway resistance by impulse oscillometry

AAPC RationaleNew code 94728 (along with new codes 94726 Plethysmogra-phy for determination of lung volumes and, when performed, airway resistance and 94727 Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes) replaces deleted codes 94260, 94350, 94360, and 94370. Impulse oscillometry is complementary to spi-rometry in the early detection and follow up of pulmonary diseases such as asthma, chronic obstructive pulmonary dis-ease (COPD) and idiopathic pulmonary fibrosis.

Pulmonary/Other Proceduresl +94729 Diffusing capacity (eg, carbon monoxide, membrane) (List separately in addition to code for primary procedure)

AAPC RationaleDiffusion capacity is a measurement of the lung’s ability to transfer gases (ie, how efficiently the lungs take up oxygen), used to diagnose conditions such as emphysema or intersti-tial lung diseases.

Code 94729 is an add-on for use with 94010, 94060, 94070, 94375, and 94726–94728.

Pulmonary/Other Proceduresl 94780 Car seat/bed testing for airway integrity, neonate, with continual nursing observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with inter-pretation and report; 60 minutes

AAPC RationaleCode 94780 (and 94781, below) describes the “car seat chal-lenge.” Physiological monitoring studies indicate that some preterm infants experience episodes of oxygen desaturation, apnea, or bradycardia when seated in standard car safety seats. The American Academy of Pediatrics recommends that all preterm infants should be assessed for cardiorespiratory stability in their car seat prior to discharge.

Code 94780 is time based: Do not report 94780 for less than 60 minutes of testing. Rhythm ECG (93040–93042), non-invasive ear or pulse oximetry (94760, 94761), inpatient neo-natal critical care (99468–99472), and initial hospital care, neonate (99477–99480) are included in 94780, and should not be reported separately.

Procedure


Pulmonary/Other Proceduresl +94781 Car seat/bed testing for airway integrity, neonate, with continual nursing observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with inter-pretation and report; each additional full 30 minutes (List separately in addition to code for primary procedure)

AAPC RationaleCode 94781 is an add-on code to be reported only in addi-tion to 94780 for each additional 30 minutes of car seat/bed testing for airway integrity, neonate, beyond the first hour. Do not report 94781 for less than 30 additional min-utes. For example, for 80 minutes of testing, correct coding is 94780 only; for 110 minutes of testing, correct coding is 94780, 94781.

The American Academy of Pediatrics recommends that all preterm infants should be assessed for cardiorespiratory sta-bility in their car seat prior to discharge.

Neurology and Neuromuscular Procedures/Electromyographyl # +95885 Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (List separately in addition to code for primary procedure)

AAPC RationaleAdd-on codes 95885–95887 have been added to describe needle electromyography performed with nerve conduc-tion, amplitude and latency/velocity study. Code 95885 applies per extremity and describes a limited study (eg, four or fewer muscles are tested per extremity), and should be reported in addition to a primary nerve conduction study code from the range 95900–95904.

Do not report 95885 in addition to 95905 Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report. Do not report 95885 with 95860–95864, 95870, or 95905, which describe similar EMG studies without with nerve conduc-tion, amplitude, and latency/velocity study.

Neurology and Neuromuscular Procedures/Electromyographyl # +95886 Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (List separately in addition to code for primary procedure)

AAPC RationaleAdd-on codes 95885–95887 have been added to describe needle electromyography performed with nerve conduc-tion, amplitude and latency/velocity study. Code 95886 applies per extremity and describes a complete study (eg, five or more muscles are tested per extremity), and should be reported in addition to a primary nerve conduction study code from the range 95900–95904.

Do not report 95886 in addition to 95905 Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report. Do not report 95885 with 95860–95864, 95870, or 95905, which describe similar EMG studies without with nerve conduction, amplitude, and latency/velocity study.

Neurology and Neuromuscular Procedures/Electromyographyl # +95887 Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (List separately in addition to code for primary procedure)

AAPC RationaleAdd-on codes 95885–95887 have been added to describe needle electromyography performed with nerve conduc-tion, amplitude and latency/velocity study. Code 95887 describes testing of non-extremities (eg, muscles supplied by the cranial nerve) and should be reported in addition to a primary nerve conduction study code from the range 95900–95904.

Do not report 95886 in addition to 95905 Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report. Do not report 95885 with 95867–95870, or 95905, which describe similar EMG studies without with nerve conduction, amplitude, and latency/velocity study.

Procedure


Neurology and Neuromuscular Procedures/Electromyographyl # 95938 Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs

AAPC RationaleCode 95938 has been added to describe short latency somatosensory evoked potential studies of both the upper and lower limbs. In a sensory evoked potential the exam-iner stimulates a sense (touch), and the length of time for the electrical potential (or signal) to travel to the brain is measured. Such studies may be helpful to diagnose condi-tions such as brain death, coma, multiple sclerosis and other demyelinating diseases, spinal cord trauma, and more.

For study of the upper limbs only, report 95925 Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs; for study of the lower limbs only, report 95926 Short-latency somatosensory evoked poten-tial study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in lower limbs.

Neurology and Neuromuscular Procedures/Electromyographyl # 95939 Central motor evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs

AAPC RationaleCode 95939 has been added to describe central motor evoked potential study of both the upper and lower limbs. In a motor evoked potential, the examiner stimulates the brain and measures the response time to the muscles.

For study of the upper limbs only, report 95925 Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs; for study of the lower limbs only, report 95926 Short-latency somatosensory evoked poten-tial study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in lower limbs.

Neurology and Neuromuscular Procedures/Neurostimulators, Analysis-Programming 95970 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and, pulse duration, configuration of wave form, battery status, elec-trode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, autonomic sacral nerve, neuromuscular) neurostimula-tor pulse generator/transmitter, without reprogramming

AAPC RationaleCodes 95970–+95975 have undergone minor descriptor revi-sions to clarify their use; the term “sacral” has been added to describe more precisely the nerves being tested.

Code 95970 describes subsequent electronic analysis of a previously implanted simple or complex brain, spinal cord, or peripheral neurostimulator pulse generator, without repro-gramming. Such a system uses an implanted pulse generator and implanted electrodes to deliver low voltage electrical stimulation to targeted nerves, for instance for pain relief.

Neurology and Neuromuscular Procedures/Neurostimulators, Analysis-Programming 95971 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and, pulse duration, configuration of wave form, battery status, elec-trode selectability, output modulation, cycling, impedance and patient compliance measurements); simple spinal cord, or peripheral (ie, peripheral nerve, autonomic sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming


Code 95971 describes either intraoperative (initial) or subse-quent electronic analysis of a simple implanted spinal cord or peripheral neurostimulator pulse generator system, with pro-gramming. Simple programming includes changes to three or fewer of the following parameters: rate, pulse amplitude, pulse duration, pulse frequency, eight or more electrode contacts, cycling, stimulation train duration, train spac-ing, number of programs, number of channels, alternating electrode polarities, dose time, and more than one clinical feature (eg, rigidity, dyskinesia, tremor).

Procedure


Neurology and Neuromuscular Procedures/Neurostimulators, Analysis-Programming 95972 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and, pulse duration, configuration of wave form, battery status, elec-trode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (ie, peripheral nerve, autonomic nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subse-quent programming, first hour


Code 95972 describes either intraoperative (initial) or subse-quent complex electronic analysis of an implanted spinal cord or peripheral (except cranial) neurostimulator pulse generator system, with programming. Complex analysis/programming includes changes four or more of the following parameters: rate, pulse amplitude, pulse duration, pulse frequency, eight or more electrode contacts, cycling, stimulation train dura-tion, train spacing, number of programs, number of chan-nels, alternating electrode polarities, dose time, and more than one clinical feature (eg, rigidity, dyskinesia, tremor).

Code 95972 is time-based, and should be reported once for the first documented hour of reprogramming time. For additional reprogramming beyond the first hour, see add-on 95973, below.

Neurology and Neuromuscular Procedures/Neurostimulators, Analysis-Programming +95973 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (ie, peripheral nerve, autonomic nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent pro-gramming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)

AAPC RationaleCodes 95970–+95975 have undergone minor descriptor revisions to clarify their use.

Code 95973 describes additional intraoperative (initial) or subsequent complex electronic analysis and programming, beyond the first hour, of an implanted spinal cord or periph-eral (except cranial) neurostimulator pulse generator system. Complex programming includes changes four or more of the following parameters: rate, pulse amplitude, pulse duration, pulse frequency, eight or more electrode contacts, cycling, stimulation train duration, train spacing, number of pro-grams, number of channels, alternating electrode polarities, dose time, and more than one clinical feature (eg, rigidity, dyskinesia, tremor).

Code 95973 is time-based, and should be reported with 95972 for each 30 minutes beyond the first hour of docu-mented hour of reprogramming time.

Neurology and Neuromuscular Procedures/Neurostimulators, Analysis-Programming 95974 Electronic analysis of implanted neurostimula-tor pulse generator system (eg, rate, pulse amplitude and, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, imped-ance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour

AAPC RationaleCodes 95970–+95975 have undergone minor descriptor revi-sions to clarify their use.

Code 95974 describes either intraoperative (initial) or subse-quent complex electronic analysis of a complex cranial nerve neurostimulator pulse generator/transmitter, with program-ming. Complex analysis/programming includes changes four or more of the following parameters: rate, pulse amplitude, pulse duration, pulse frequency, eight or more electrode contacts, cycling, stimulation train duration, train spac-ing, number of programs, number of channels, alternating electrode polarities, does time, and more than one clinical feature (eg, rigidity, dyskinesia, tremor).

Code 95974 is time-based, and should be reported once for the first documented hour of reprogramming time. For additional reprogramming beyond the first hour, see add-on 95975, below.

Procedure


Neurology and Neuromuscular Procedures/Neurostimulators, Analysis-Programming +95975 Electronic analysis of implanted neurostimula-tor pulse generator system (eg, rate, pulse amplitude and, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, imped-ance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)

AAPC RationaleCodes 95970–+95975 have undergone minor descriptor revi-sions to clarify their use.

Add-on code 95975 describes additional intraoperative (initial) or subsequent complex electronic analysis and pro-gramming, beyond the first hour, of a complex cranial nerve neurostimulator pulse generator/transmitter. Complex pro-gramming includes changes four or more of the following parameters: rate, pulse amplitude, pulse duration, pulse fre-quency, eight or more electrode contacts, cycling, stimulation train duration, train spacing, number of programs, number of channels, alternating electrode polarities, dose time, and more than one clinical feature (eg, rigidity, dyskinesia, tremor).

Code 95975 is time-based, and should be reported with 95974 for each 30 minutes beyond the first hour of docu-mented hour of reprogramming time.

Neurology and Neuromuscular Procedures/Other Procedures 95990 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed

AAPC RationaleCode 95990 has been updated to specify that electronic analysis, when performed, is an included component of refill-ing and maintenance of implantable spinal or brain pump or reservoir for drug delivery. Implantable drug pumps are generally used for pain management and relief.

For services requiring a physician’s skill, see 95991, below.

Neurology and Neuromuscular Procedures/Other Procedures 95991 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; administered by requiring physician’s skill

AAPC RationaleCode 95991 has been updated to specify that electronic analysis, when performed, is an included component of refill-ing and maintenance of implantable spinal or brain pump or reservoir for drug delivery. Implantable drug pumps are generally used for pain management and relief.

This code may be used only when the service requires a phy-sician’s skill, and a physician provides the service. For services not requiring a physician’s skill or not performed by a physi-cian, see 95990, above.

Neurology and Neuromuscular Procedures/Central Nervous System Assessments-Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) 96110 Developmental testing screening, with interpreta-tion and report, per standardized instrument form; limited (eg, Developmental Screening Test II, Early Language Mile-stone Screen), with interpretation and report

AAPC RationaleCode language has been revised to provide clarity and to delete references to obsolete tests. Screening, as described by 96110, is subjective and based on observations recorded on a standard form. Developmental testing (96111), by contrast, is objective and requires that the child perform specific tasks of a standardized test.

Neurology and Neuromuscular Procedures/Central Nervous System Assessments-Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) 96111 Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive function-ing by standardized developmental instruments) with inter-pretation and report extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report

Procedure


AAPC RationaleCode language has been revised to provide clarity. Devel-opmental testing is an objective, face-to-face assessment of a child’s skills that and requires the child to perform tasks associated with a standardized test. Screening as described by 96110, by contrast, relies on subjective observations of a child’s abilities.

Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration) +96367 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)

AAPC RationaleA sequential infusion is an infusion (or IV push) of a new substance or drug following a primary or initial service (eg, 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour). The descriptor for 96367 has been revised to specify the requirement for a new substance or drug.

Code 96367 is an add-on to be used only in addition to 96365, 96374 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial sub-stance/drug, 96409 Chemotherapy administration; intravenous, push technique, single or initial substance/drug, or 96413 Che-motherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug. Report a single unit of 96367 per sequential infusion of the same infusate mix.

CPT® guidelines allow facilities to report a sequential intra-venous push of the same drug using 96376 Therapeutic, pro-phylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for pri-mary procedure).

Category II CodesCategory II codes are supplemental tracking codes that can be used for performance measurement under Medicare’s Physician Quality Reporting System (PQRS) or private payer pay-for-performance programs. Use of Category II codes is

optional; they are not tied to a fee schedule and are intended for data collection regarding quality of care.

For 2012, CPT® has added 59 new Category II codes, revised five codes, deleted five codes, and reinstated two codes. For additional information, consult your CPT® manual or the AMA website at: http://www.ama-assn.org/go/cpt. You will find a dedicated link for Category II codes to the right of the screen, under the “Related Links” menu.

Category III CodesCategory III codes describe emerging technologies and, unlike Category I “unlisted procedure” codes, allow for tracking and collection of specific data. If a Category III code is available, it must be reported instead of a Category I unlisted procedure code. Category III codes have a five-year life span: Per CPT®

guidelines, if a Category III code is not replaced by a Category I code (or otherwise revised) within five years, the Category III code will be archived “unless it is demonstrated that a temporary code is still needed.”

Category III Code 0080T Endovascular repair using prosthesis of abdominal aortic aneurysm, pseudoaneurysm or dissection, abdominal aorta involving visceral vessels (superior mesenteric, celiac and/or renal) using fenestrated modular bifurcated prosthe-sis (2 docking limbs artery[s]), radiological supervision and interpretation

AAPC RationaleCode descriptor language has been revised to better specify the procedures that are intended as part of the service.

Category III Code0143T Laparoscopy, surgical, pancreatic islet cell transplanta-tion through portal vein

AAPC RationaleCode 0143T has been deleted for 2012. The AMA now recommends reporting pancreatic islet cell transplantation using Category I unlisted procedure code 48999 Unlisted procedure, pancreas.

Procedure


Category III Code0155T Laparoscopy, surgical; implantation or replacement of gastric stimulation electrodes, lesser curvature (ie, morbid obesity)

AAPC RationaleCodes 0155T and 0156T, below, have been deleted for 2012. The AMA now recommends reporting laparoscopic implanta-tion, replacement, revision, or removal of gastric stimulation electrodes (lesser curvature) using Category I unlisted pro-cedure code 43659 Unlisted laparoscopy procedure, stomach. For open procedures, see 43999 Unlisted procedure, stomach.

Category III Code0156T Laparoscopy, surgical; revision or removal of gastric stimulation electrodes, lesser curvature (ie, morbid obesity)

AAPC RationaleCodes 0156T and 0155T, above, have been deleted for 2012. The AMA now recommends reporting laparoscopic implanta-tion, replacement, revision, or removal of gastric stimulation electrodes (lesser curvature) using Category I unlisted pro-cedure code 43659 Unlisted laparoscopy procedure, stomach. For open procedures, see 43999 Unlisted procedure, stomach.

Category III Code0157T Laparotomy, implantation or replacement of gastric stimulation electrodes, lesser curvature (ie, morbid obesity)

AAPC RationaleCodes 0157T and 0158T, below, have been deleted for 2012. The AMA now recommends reporting open implantation, replacement, revision, or removal of gastric stimulation elec-trodes (lesser curvature) using Category I unlisted procedure code 43999 Unlisted procedure, stomach. For laparoscopic proce-dures, see 43659 Unlisted laparoscopy procedure, stomach.

Category III Code0158T Laparotomy, revision or removal of gastric stimulation electrodes, lesser curvature (ie, morbid obesity)

AAPC RationaleCodes 0158T and 0157T, above, have been deleted for 2012. The AMA now recommends reporting open implantation, replacement, revision, or removal of gastric stimulation elec-trodes (lesser curvature) using Category I unlisted procedure code 43999 Unlisted procedure, stomach. For laparoscopic proce-dures, see 43659 Unlisted laparoscopy procedure, stomach.

Category III Code0166T Transmyocardial transcatheter closure of ventricular septal defect, with implant; without cardiopulmonary bypass

AAPC RationaleCodes 0166T and 0167T, below, have been deleted for 2012. The AMA now recommends reporting transmyo-cardial transcatheter closure of ventricular septal defect with implant (including cardiopulmonary bypass, when performed) using category I unlisted procedure code 33999 Unlisted procedure, cardiac surgery.

Category III Code0167T Transmyocardial transcatheter closure of ventricular septal defect, with implant; with cardiopulmonary bypass

AAPC RationaleCodes 0167T and 0166T, above, have been deleted for 2012. The AMA now recommends reporting transmyo-cardial transcatheter closure of ventricular septal defect with implant (including cardiopulmonary bypass, when performed) using category I unlisted procedure code 33999 Unlisted procedure, cardiac surgery.

Category III Code0168T Rhinophototherapy, intranasal application of ultravio-let and visible light, bilateral

AAPC RationaleCode 0168T has been deleted for 2012. The AMA now rec-ommends reporting rhinophototherapy (intranasal applica-tion of ultraviolet and visible light) using category I unlisted procedure code 30999 Unlisted procedure, nose.

Category III Code 0240T Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with 3 dimensional high resolution esophageal pressure topography

AAPC RationaleCategory III code 0240T describes high-resolution esopha-geal motility studies. Like 91010 Esophageal motility (mano-metric study of the esophagus and/or gastroesophageal junction) study with interpretation and report, high resolution esophageal pressure topography (HREPT) plots both time and pressure, but adds spatial locale and provides enhanced spatial resolu-tion compared for evaluation of esophageal motility disorders

Procedure


such as achalasia or esophageal spasm. These procedures occur without pressure topography.

Category III Code +0241T Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion during 3 dimensional high resolution esophageal pressure topography study (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for primary procedure)

AAPC RationaleAdd-on Category III code 0241T describes high resolution esophageal motility studies with stimulation or perfusion. Like 91013 Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion during (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for primary procedure), high resolution esophageal pressure topography (HREPT) plots both time and pressure, but adds spatial locale and provides enhanced spatial resolution for evalu-ation of esophageal motility disorders such as achalasia or esophageal spasm. These procedures occur without pressure topography.

Category III Codel 0260T Total body systemic hypothermia, per day, in the neonate 28 days of age or younger

AAPC RationaleSystemic hypothermia may be used to treat neonates exposed to hypoxia and ischemia at birth. Code 0260T describes total body hypothermia for neonates age 28 days or younger. Codes 0260T and 0261T were accepted at the June 2010 CPT® Editorial Panel meeting for the 2012 CPT® production cycle. Therefore, the codes did not appear in the 2011 CPT® codebook; however, due to the Category III code early release policy, these codes were effective Jan. 1, 2011.

Category III Codel 0261T Selective head hypothermia, per day, in the neonate 28 days of age or younger

AAPC RationaleSelective hypothermia may be used to treat neonates exposed to hypoxia and ischemia at birth. Code 0261T describes selective head hypothermia for neonates age 28 days or younger. Codes 0260T and 0261T were accepted at the June

2010 CPT® Editorial Panel meeting for the 2012 CPT® production cycle. Therefore, the codes did not appear in the 2011 CPT® codebook; however, due to the Category III code early release policy, these codes were effective Jan. 1, 2011.

Category III Codel 0262T Implantation of catheter-delivered prosthetic pul-monary valve, endovascular approach

AAPC RationaleTranscatheter heart valve replacement is a minimally inva-sive procedure in which a catheter is inserted using an endo-vascular approach to introduce an expandable pulmonary valve that is delivered to the diseased native valve. Code 0262T includes many related procedures, including all car-diac catheterizations, intraprocedural contrast injections, fluoroscopic radiological supervision and interpretation and imaging guidance necessary to complete the procedure.

Category III Codel 0263T Intramuscular autologous bone marrow cell ther-apy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; com-plete procedure including unilateral or bilateral bone marrow harvest

AAPC RationalePeripheral arterial disease (PAD) is a common circulatory problem in which narrowed arteries reduce blood flow, espe-cially to the limbs. In patients affected by limb ischemia, local intramuscular autologous bone marrow cell therapy has shown encouraging results with consistent revascularization of affected limbs. Code 0263T describes the complete pro-cedure, including both bone marrow cell therapy and bone marrow harvest. When reporting the complete procedure (0263T), do not separately report component services (0264T and 0265T).

Do not report 0263T with bone marrow or stem cell ser-vices/ procedures 38204–38242; ultrasonic guidance for needle placement 76942; or duplex scan of lower extremity arteries or arterial bypass grafts 93925 and 93926.

Procedure


Category III Codel 0264T Intramuscular autologous bone marrow cell ther-apy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; com-plete procedure excluding bone marrow harvest

AAPC RationalePeripheral arterial disease (PAD) is a common circulatory problem in which narrowed arteries reduce blood flow, espe-cially to the limbs. In patients affected by limb ischemia, local intramuscular autologous bone marrow cell therapy has shown encouraging results with consistent revasculariza-tion of affected limbs. Code 0264T describes bone marrow cell therapy only. Do not separately report this service with the complete procedure (0263T), which includes both bone marrow cell therapy and bone marrow harvest.

Do not report 0263T with bone marrow or stem cell ser-vices/ procedures 38204–38242; ultrasonic guidance for needle placement 76942; or duplex scan of lower extremity arteries or arterial bypass grafts 93925 and 93926.

Category III Codel 0265T Intramuscular autologous bone marrow cell ther-apy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; unilat-eral or bilateral bone marrow harvest only for intramuscular autologous bone marrow cell therapy

AAPC RationalePeripheral arterial disease (PAD) is a common circulatory problem in which narrowed arteries reduce blood flow, espe-cially to the limbs. In patients affected by limb ischemia, local intramuscular autologous bone marrow cell therapy has shown encouraging results with consistent revascularization of affected limbs. Code 0265T describes bone marrow har-vest only. Do not separately report this service with the com-plete procedure (0263T), which includes both bone marrow cell therapy and bone marrow harvest.

Do not report 0263T with bone marrow or stem cell services/procedures 38204–38242.

Category III Codel 0266T Implantation or replacement of carotid sinus baroreflex activation device; total system (includes genera-tor placement, unilateral or bilateral lead placement, intra-operative interrogation, programming, and repositioning, when performed)

AAPC RationaleThe baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for maintaining blood pressure. Electrical activation of the carotid baroreflex has potential therapeutic value to control hypertension (high blood pres-sure).

Code 0266T describes implantation or replacement of a com-plete carotid sinus baroreflex activation device. For implanta-tion or replacement of individual system components (lead or pulse generator), see 0267T and 0268T, below. For revision or removal, see 0269T–0271T. For device interrogation and programming only, see 0272T–0273T.

Category III Codel 0267T Implantation or replacement of carotid sinus baro-reflex activation device; lead only, unilateral (includes intra-operative interrogation, programming, and repositioning, when performed)

AAPC RationaleThe baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for maintaining blood pressure. Electrical activation of the carotid baroreflex has potential therapeutic value to control hypertension (high blood pressure).

Code 0267T describes implantation or replacement of a carotid sinus baroreflex activation device lead, alone. Bilat-eral procedures may be reported with modifier 50 Bilateral procedure.

For implantation or replacement of a complete system, see 0267T, above. For implantation or replacement of pulse gen-erator only, see 0268T, below. For revision or removal, see 0269T–0271T. For device interrogation and programming only, see 0272T–0273T.

Do not report 0267T in addition to 0266T or 0269T–0273T.

Category III Codel 0268T Implantation or replacement of carotid sinus baro-reflex activation device; pulse generator only (includes intra-operative interrogation, programming, and repositioning, when performed)

AAPC RationaleThe baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for maintaining blood pressure.

Procedure


Electrical activation of the carotid baroreflex has potential therapeutic value to control hypertension (high blood pressure).

Code 0268T describes implantation or replacement of a carotid sinus baroreflex activation device pulse genera-tor, alone. For implantation or replacement of a complete system, see 0266T, above. For implantation or replacement of lead only, see 0267T, above. For revision or removal, see 0269T–0271T. For device interrogation and programming only, see 0272T–0273T.

Do not report 0268T in addition to 0266T or 0269T–0273T

Category III Codel 0269T Revision or removal of carotid sinus baroreflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interro-gation, programming, and repositioning, when performed)


Code 0269T describes revision or removal of a complete carotid sinus baroreflex activation device. For revision or removal of individual system components (lead or pulse generator), see 0270T and 0271T, below. For implantation or replacement, see 0266T–0278T. For device interrogation and programming only, see 0272T–0273T.

Do not report 0269T with 0266T–0268T or 0270T–0273T.

Category III Codel 0270T Revision or removal of carotid sinus baroreflex activation device; lead only, unilateral (includes intra-oper-ative interrogation, programming, and repositioning, when performed)


Code 0270T describes revision or removal of a carotid sinus baroreflex activation device lead, alone. For bilateral removal, you may append modifier 50 Bilateral procedure.

For revision or removal of a complete system, see 0269T, above. For revision or removal of pulse generator only, see 0271T, below. For implantation or replacement, see 0266T–0278T. For device interrogation and programming only, see 0272T–0273T.

Do not report 0266T–0269T or 0271T–0273T in addition to 0270T.

Category III Codel 0271T Revision or removal of carotid sinus baroreflex acti-vation device; pulse generator only (includes intra-operative interrogation, programming, and repositioning, when per-formed)

AAPC RationaleThe baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for maintaining blood pressure. Electrical activation of the carotid baroreflex has potential therapeutic value to control hypertension (high blood pres-sure).

Code 0271T describes revision or removal of a carotid sinus baroreflex activation device pulse generator. For revision or removal of a complete system, see 0269T, above. For revision or removal of lead only, see 0270T, above. For implantation or replacement, see 0266T–0278T. For device interrogation and programming, see 0272T–0273T.

Do not report 0271T with 0266T–0270T or 0272T–0273T.

Category III Codel 0272T Interrogation device evaluation (in person), carotid sinus baroreflex activation system, including telemetric itera-tive communication with the implantable device to monitor device diagnostics and programmed therapy values, with interpretation and report (eg, battery status, lead impedance, pulse amplitude, pulse width, therapy frequency, pathway mode, burst mode, therapy start/stop times each day

AAPC RationaleThe baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for maintaining blood pressure. Elec-trical activation of the carotid baroreflex has potential thera-

Procedure


peutic value to control hypertension (high blood pressure). Code 0272T describes in-person device interrogation only.

Do not report 0272T with 0266T–0271T or 0273T.

Category III Codel 0273T Interrogation device evaluation (in person), carotid sinus baroreflex activation system, including telemetric itera-tive communication with the implantable device to monitor device diagnostics and programmed therapy values, with interpretation and report (eg, battery status, lead impedance, pulse amplitude, pulse width, therapy frequency, pathway mode, burst mode, therapy start/stop times each day; with programming

AAPC RationaleThe baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for maintaining blood pressure. Electrical activation of the carotid baroreflex has potential therapeutic value to control hypertension (high blood pres-sure). Code 0273T describes in-person device interrogation with programming.

Do not report 0273T with 0266T–0272T.

Category III Codel 0274T Percutaneous laminotomy/laminectomy (interlami-nar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guid-ance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic

AAPC RationaleSpinal decompression procedures are performed to remove pressure from spinal nerves and relieve pain. Open laminot-omy/laminectomy for decompression have been the standard, but less invasive techniques have been developed in recent years. Percutaneous laminotomy/laminectomy for spinal decompression is performed using a single 6 gauge portal site that involves a stab wound incision, resulting in less patient trauma and a quicker recovery. This method does not require fixation/stabilization devices or spacers, and can be conducted under a combination of local anesthetic and moni-tored anesthesia care (MAC), rather than general anesthesia. Code 0274T describes such a technique at single or multiple spinal levels, unilateral or bilateral, in either the cervical or thoracic regions of the spine.

For similar technique of the lumbar spine, see 0275T, below. For open and endocscopically-assisted approach, see 63020–63035. For percutaneous decompression of the nucleus pulp-osus of intervertebral disc using need-based technique, see 62287 Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar (eg, manual or automated percutaneous discectomy, percutaneous laser discectomy).

Category III Codel 0275T Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; lumbar

AAPC RationaleSpinal decompression procedures are performed to remove pressure from spinal nerves and relieve pain. Open laminot-omy/laminectomy for decompression have been the standard, but less invasive techniques have been developed in recent years. Percutaneous laminotomy/laminectomy for spinal decompression is performed using a single 6 gauge portal site that involves a stab wound incision, resulting in less patient trauma and a quicker recovery. This method does not require fixation/stabilization devices or spacers, and can be conducted under a combination of local anesthetic and moni-tored anesthesia care (MAC), rather than general anesthesia. Code 0275T describes such a technique at single or multiple spinal levels, unilateral or bilateral, in lumbar region of the spine.

For similar technique of the cervical or thoracic spine, see 0274T, above. For open and endocscopically-assisted approach, see 63020–63035. For percutaneous decompression of the nucleus pulposus of intervertebral disc using need-based technique, see 62287 Decompression procedure, percutane-ous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar (eg, manual or automated percutaneous discectomy, percutaneous laser discectomy).

Code 0275T takes the place of deleted HCPCS Level II code C9729.

Category III Codel 0276T Bronchoscopy, rigid or flexible, including fluo-roscopic guidance, when performed; with bronchial thermo-plasty, 1 lobe

Procedure


AAPC RationaleBronchial thermoplasty is a minimally-invasive, non-drug procedure for severe persistent asthma for patients whose asthma is not well-controlled with inhaled corticosteroids and long-acting beta-agonists. Thermal energy is delivered to the airway wall to reduce excessive airway smooth muscle (ASM). Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks.

Code 0276T describes this procedure for a single lobe of the lung. Fluoroscopic guidance (when performed) and moderate sedation are included. For treatment of two or more lobes, see 0277T, below.

Category III Codel 0277T Bronchoscopy, rigid or flexible, including fluo-roscopic guidance, when performed; with bronchial thermo-plasty, 2 or more lobes

AAPC RationaleBronchial thermoplasty is a minimally-invasive, non-drug procedure for severe persistent asthma for patients whose asthma is not well-controlled with inhaled corticosteroids and long-acting beta-agonists. Thermal energy is delivered to the airway wall to reduce excessive airway smooth muscle (ASM). Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks.

Code 0277T describes this procedure for two or more lobes of the lung. Fluoroscopic guidance (when performed) and moderate sedation are included. For treatment of a single lobe, see 0276T, above.

Category III Codel 0278T Transcutaneous electrical modulation pain repro-cessing (eg, scrambler therapy), each treatment session (includes placement of electrodes)

AAPC RationaleCode 0278T describes use of the Calmare® device for treat-ment of chemotherapy-induced peripheral neuropathy (CIPN) and other neuropathic pain. The therapy treats pain using a biophysical approach rather than through the use of drugs. Surface electrodes are applied to the skin. The device creates and sends a no-pain signal that becomes the domi-nant signal received by the brain, thus overriding the pain signal.

Category III Codel 0279T Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood);

AAPC RationaleCode 0279T describes circulation tumor cells (CTC) enumer-ation, to determine disease prognosis and treatment options in cancer patients. For interpretation and report, see 0280T.

Category III Codel 0280T Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); interpretation and report

AAPC RationaleCode 0280T describes interpretation and report of circula-tion tumor cells (CTC) enumeration, to determine disease prognosis and treatment options in cancer patients. Use with 0279T.

Category III Codel 0281T Percutaneous transcatheter closure of the left atrial appendage with implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, radiological supervision and interpretation

AAPC RationaleCode 0281T describes transcatheter placement of an implant to close the left atrial appendage, with the intent to deter formation of emboli. Do not report 0281T in addition to left heart catheterization (93462). CPT® provides additional instruction regarding which procedures may be reported separately.

Category III Codel 0282T Percutaneous or open implantation of neuro-stimulator electrode array(s), subcutaneous (peripheral sub-cutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic or lumbar; for trial, including removal at the conclusion of

AAPC RationaleCodes 0282T–0284T have been added to describe periph-eral field stimulation to treat chronic cervical, thoracic, or lumbar pain. Unlike peripheral nerve stimulation, field

Procedure


stimulation does not target a specific nerve; rather, electrode leads are placed in subcutaneous tissue to deliver electrical stimulation in a general area. Imaging guidance is included, when performed.

Code 0282T describes a trial placement.

Category III Codel 0283T Percutaneous or open implantation of neuro-stimulator electrode array(s), subcutaneous (peripheral sub-cutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic or lumbar; permanent, with implantation of a pulse generator

AAPC RationaleCodes 0282T–0284T have been added to describe periph-eral field stimulation to treat chronic cervical, thoracic, or lumbar pain. Unlike peripheral nerve stimulation, field stimulation does not target a specific nerve; rather, electrode leads are placed in subcutaneous tissue to deliver electrical stimulation in a general area. Imaging guidance is included, when performed.

Code 0283T describes a permanent placement.

Category III Codel 0284T Revision or removal of pulse generator or electrodes, including imaging guidance, when performed, including addition of new electrodes, when performed

AAPC RationaleCodes 0282T–0284T have been added to describe periph-eral field stimulation to treat chronic cervical, thoracic, or lumbar pain. Unlike peripheral nerve stimulation, field stimulation does not target a specific nerve; rather, electrode leads are placed in subcutaneous tissue to deliver electrical stimulation in a general area. Imaging guidance is included, when performed.

Code 0284T describes revision/removal of pulse generator or electrodes, with placement of new electrodes, when performed.

Category III Codel 0285T Electronic analysis of implanted peripheral subcu-taneous field stimulation pulse generator, with reprogram-ming when performed

AAPC Rationale

Codes 0282T–0284T have been added to describe periph-eral field stimulation to treat chronic cervical, thoracic, or lumbar pain. Unlike peripheral nerve stimulation, field stimulation does not target a specific nerve; rather, electrode leads are placed in subcutaneous tissue to deliver electrical stimulation in a general area. Imaging guidance is included, when performed.

Code 0285T describes analysis and reprogramming (when performed) of the pulse generator.

Category III Codel 0286T Near-infrared spectroscopy studies of lower extremity wounds (eg, for oxyhemoglobin measurement)

AAPC RationaleNear-infrared spectroscopy measures the percentage of hemoglobin oxygen saturation in the microcirculation of tissue up to 3 cm below the skin, and is potentially useful in assessing patients with peripheral arterial disease (PAD), acute compartment syndrome (ACS), and more. Code 0286T describes near-infrared spectroscopy studies of lower extrem-ity wounds.

Category III Codel 0287T Near-infrared guidance for vascular access requir-ing real-time digital visualization of subcutaneous vascula-ture for evaluation of potential access sites and vessel patency

AAPC RationaleNear-infrared guidance is a technology that allows clinicians to more easily visualize blood vessels and gain venous access for those patients with difficult venous access (DVA). The technology uses near-infrared light, coupled with advanced technologies, to display an image of superficial vasculature directly onto a patient’s skin, which removes any doubt of locating a vessel for peripheral or central venous access.

Code 0287T describes this real-time digital projection of subcutaneous structures to locate hard-to-find vessels.

Category III Codel 0288T Anoscopy, with delivery of thermal energy to the muscle of the anal canal (eg, for fecal incontinence)

AAPC RationaleCode 0288T describes the delivery of radiofrequency energy to the muscles of the anal canal, resulting in a change in tissue compliance and a corresponding improvement in

Procedure


incontinence symptoms. The procedure takes approximately one hour and is performed in an outpatient setting with the patient sedated.

Do not report 0288T with anoscopy procedures 46600–46615.

Category III Codel +0289T Corneal incisions in the donor cornea created using a laser, in preparation for penetrating or lamellar keratoplasty (List separately in addition to code for primary procedure)

AAPC RationaleKeratoplasty, or cornea transplant, describes replacement of central corneal tissue damaged by eye disease or injury. Cornea transplants are routine, and are the most successful type of tissue transplants. Donor material must be obtained to perform the graft; add-on +0289T describes the use of a laser to prepare the donor cornea.

Report +0289T only with approved primary procedures 65710 Keratoplasty (corneal transplant); anterior lamellar, 65730 Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia), 65750 Keratoplasty (corneal transplant); penetrat-ing (in aphakia), and 65755 Keratoplasty (corneal transplant); penetrating (in pseudophakia).

Category III Codel +0290T Corneal incisions in the recipient cornea cre-ated using a laser, in preparation for penetrating or lamellar keratoplasty (List separately in addition to code for primary procedure)

AAPC RationaleKeratoplasty, or cornea transplant, describes replacement of central corneal tissue damaged by eye disease or injury. Cornea transplants are routine, and are the most successful type of tissue transplants. Add-on +0290T describes graft preparation of the recipient cornea by laser incision.

Report +0290T only with approved primary procedures 65710 Keratoplasty (corneal transplant); anterior lamellar, 65730 Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia), 65750 Keratoplasty (corneal transplant); penetrat-ing (in aphakia), and 65755 Keratoplasty (corneal transplant); penetrating (in pseudophakia).

Complete2012 ProcedureCoding Updates & Rationales

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